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 June 30, 20192020

Commission file number001-15925

COMMUNITY HEALTH SYSTEMS, INC.

(Exact name of registrant as specified in its charter)

 

Delaware

Delaware

13-3893191

(State or other jurisdiction of

incorporation or organization)

(I.R.S. Employer

Identification Number)

4000 Meridian Boulevard

Franklin, Tennessee

37067

(Zip Code)

(Address of principal executive offices)

615-465-7000

615-465-7000

(Registrant’s telephone number)

 

Securities registered pursuant to Section 12(b) of the Act:

 

Title of each class

Trading Symbol(s)

Name of each exchange on which registered

Common Stock, $.01 par value

CYH

CYH

New York Stock Exchange

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   No 

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 ofRegulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).  Yes     No 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, anon-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule12b-2 of the Exchange Act.

 

Large accelerated filer 

Accelerated filer 

Smaller reporting company 

Non-accelerated filer 

Emerging growth company

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.

Indicate by check mark whether the registrant is a shell company (as defined inRule 12b-2 of the Exchange Act).  Yes     No 

As of July 24, 2019,23, 2020, there were outstanding 118,052,308119,618,984 shares of the Registrant’s Common Stock, $0.01 par value.

 

 



Community Health Systems, Inc.

Form10-Q

For the Three and Six Months Ended June 30, 20192020

 

Part I.

Financial Information

Page

Item 1.

Financial Statements:

Condensed Consolidated Statements of LossIncome (Loss) – Three and Six Months Ended June 30, 20192020 and June 30, 20182019 (Unaudited)

2

Condensed Consolidated Statements of Comprehensive LossIncome (Loss) - Three and Six Months Ended June 30, 20192020 and June 30, 20182019 (Unaudited)

3

Condensed Consolidated Balance Sheets - June 30, 20192020 and December 31, 20182019 (Unaudited)

4

Condensed Consolidated Statements of Cash Flows – Six Months Ended June 30, 20192020 and June 30, 20182019 (Unaudited)

5

Notes to Condensed Consolidated Financial Statements (Unaudited)

6

Item 2.

Management’s Discussion and Analysis of Financial Condition and Results of Operations

53

31

Item 3.

Quantitative and Qualitative Disclosures about Market Risk

78

55

Item 4.

Controls and Procedures

78

55

Part II.

Other Information

Item 1.

Legal Proceedings

79

56

Item 1A.

Risk Factors

83

59

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

84

62

Item 3.

Defaults Upon Senior Securities

84

62

Item 4.

Mine Safety Disclosures

84

62

Item 5.

Other Information

84

62

Item 6.

Exhibits

85

63

Signatures

86

Signatures

64


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF LOSSINCOME (LOSS)

(In millions, except share and per share data)

(Unaudited)

 

  Three Months Ended   Six Months Ended 

 

Three Months Ended

 

 

Six Months Ended

 

  June 30,   June 30, 

 

June 30,

 

 

June 30,

 

              2019                           2018                           2019                           2018             

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Net operating revenues

  $3,302   $3,562   $6,679   $7,251 

 

$

2,519

 

 

$

3,302

 

 

$

5,544

 

 

$

6,679

 

Operating costs and expenses:

        

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

   1,488    1,617    3,030    3,265 

 

 

1,282

 

 

 

1,488

 

 

 

2,690

 

 

 

3,030

 

Supplies

   539    592    1,097    1,208 

 

 

418

 

 

 

539

 

 

 

916

 

 

 

1,097

 

Other operating expenses

   893    879    1,704    1,789 

 

 

736

 

 

 

893

 

 

 

1,472

 

 

 

1,704

 

Government and other legal settlements and related costs

            

 

 

2

 

 

 

4

 

 

 

4

 

 

 

9

 

Electronic health records incentive reimbursement

   -    -    -    (1) 

Lease cost and rent

   81    85    162    173 

 

 

82

 

 

 

81

 

 

 

163

 

 

 

162

 

Pandemic relief funds

 

 

(448

)

 

 

 

 

 

(448

)

 

 

 

Depreciation and amortization

   153    177    305    358 

 

 

141

 

 

 

153

 

 

 

285

 

 

 

305

 

Impairment and (gain) loss on sale of businesses, net

   33    174    71    202 
  

 

   

 

   

 

   

 

 

Impairment and loss on sale of businesses, net

 

 

10

 

 

 

33

 

 

 

56

 

 

 

71

 

Total operating costs and expenses

   3,191    3,525    6,378    7,001 

 

 

2,223

 

 

 

3,191

 

 

 

5,138

 

 

 

6,378

 

  

 

   

 

   

 

   

 

 

Income from operations

   111    37    301    250 

 

 

296

 

 

 

111

 

 

 

406

 

 

 

301

 

Interest expense, net

   265    235    522    464 

 

 

260

 

 

 

265

 

 

 

523

 

 

 

522

 

Loss (gain) from early extinguishment of debt

   -    (64)    31    (59) 

Loss from early extinguishment of debt

 

 

 

 

 

 

 

 

4

 

 

 

31

 

Equity in earnings of unconsolidated affiliates

   (5)    (5)    (9)    (12) 

 

 

1

 

 

 

(5

)

 

 

(6

)

 

 

(9

)

  

 

   

 

   

 

   

 

 

Loss before income taxes

   (149)    (129)    (243)    (143) 

Income (loss) before income taxes

 

 

35

 

 

 

(149

)

 

 

(115

)

 

 

(243

)

(Benefit from) provision for income taxes

   (3)    (38)       (45) 

 

 

(58

)

 

 

(3

)

 

 

(241

)

 

 

3

 

  

 

   

 

   

 

   

 

 

Net loss

   (146)    (91)    (246)    (98) 

Net income (loss)

 

 

93

 

 

 

(146

)

 

 

126

 

 

 

(246

)

Less: Net income attributable to noncontrolling interests

   21    19    39    37 

 

 

23

 

 

 

21

 

 

 

39

 

 

 

39

 

  

 

   

 

   

 

   

 

 

Net loss attributable to Community Health Systems, Inc. stockholders

  $(167)   $(110)   $(285)   $(135) 
  

 

   

 

   

 

   

 

 

Loss per share attributable to Community Health Systems, Inc. common stockholders:

        

Net income (loss) attributable to Community Health Systems,

Inc. stockholders

 

$

70

 

 

$

(167

)

 

$

87

 

 

$

(285

)

Earnings (loss) per share attributable to Community Health

Systems, Inc. common stockholders:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Basic

  $(1.47)   $(0.97)   $(2.51)   $(1.20) 

 

$

0.61

 

 

$

(1.47

)

 

$

0.76

 

 

$

(2.51

)

  

 

   

 

   

 

   

 

 

Diluted

  $(1.47)   $(0.97)   $(2.51)   $(1.20) 

 

$

0.61

 

 

$

(1.47

)

 

$

0.76

 

 

$

(2.51

)

  

 

   

 

   

 

   

 

 

Weighted-average number of shares outstanding:

        

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Basic

   113,862,097    112,837,944    113,561,523    112,566,230 

 

 

114,972,408

 

 

 

113,862,097

 

 

 

114,636,963

 

 

 

113,561,523

 

  

 

   

 

   

 

   

 

 

Diluted

   113,862,097    112,837,944    113,561,523    112,566,230 

 

 

115,013,661

 

 

 

113,862,097

 

 

 

114,696,496

 

 

 

113,561,523

 

  

 

   

 

   

 

   

 

 

See accompanying notes to the condensed consolidated financial statements.


2


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSSINCOME (LOSS)

(In millions)

(Unaudited)

 

   Three Months Ended   Six Months Ended 
   June 30,   June 30, 
           2019                   2018                   2019                   2018         

Net loss

  $(146)   $(91)   $(246)   $(98) 

Other comprehensive income (loss), net of income taxes:

        

Net change in fair value of interest rate swaps, net of tax

   -       (2)    25 

Net change in fair value ofavailable-for-sale securities, net of tax

      (1)       (2) 

Amortization and recognition of unrecognized pension cost components, net of tax

   -       -    
  

 

 

 �� 

 

 

   

 

 

   

 

 

 

Other comprehensive income

            24 
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss

   (144)    (84)    (244)    (74) 

Less: Comprehensive income attributable to noncontrolling interests

   21    19    39    37 
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss attributable to Community Health Systems, Inc. stockholders

  $(165)   $(103)   $(283)   $(111) 
  

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Three Months Ended

 

 

Six Months Ended

 

 

 

June 30,

 

 

June 30,

 

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Net income (loss)

 

$

93

 

 

$

(146

)

 

$

126

 

 

$

(246

)

Other comprehensive income (loss), net of income taxes:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net change in fair value of interest rate swaps, net of tax

 

 

 

 

 

 

 

 

 

 

 

(2

)

Net change in fair value of available-for-sale debt securities,

   net of tax

 

 

2

 

 

 

2

 

 

 

4

 

 

 

4

 

Other comprehensive income

 

 

2

 

 

 

2

 

 

 

4

 

 

 

2

 

Comprehensive income (loss)

 

 

95

 

 

 

(144

)

 

 

130

 

 

 

(244

)

Less: Comprehensive income attributable to noncontrolling

   interests

 

 

23

 

 

 

21

 

 

 

39

 

 

 

39

 

Comprehensive income (loss) attributable to Community Health

   Systems, Inc. stockholders

 

$

72

 

 

$

(165

)

 

$

91

 

 

$

(283

)

See accompanying notes to the condensed consolidated financial statements.


3


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(In millions, except share data)

(Unaudited)

 

          June 30, 2019                December 31, 2018      

 

June 30,

2020

 

 

December 31,

2019

 

ASSETS

    

 

 

 

 

 

 

 

 

Current assets:

    

 

 

 

 

 

 

 

 

Cash and cash equivalents

  $207   $196 

 

$

1,552

 

 

$

216

 

Patient accounts receivable

   2,356    2,352 

 

 

1,925

 

 

 

2,258

 

Supplies

   378    402 

 

 

337

 

 

 

354

 

Prepaid income taxes

   -    3 

 

 

47

 

 

 

48

 

Prepaid expenses and taxes

   177    196 

 

 

178

 

 

 

193

 

Other current assets

   366    400 

 

 

374

 

 

 

358

 

  

 

   

 

 

Total current assets

   3,484    3,549 

 

 

4,413

 

 

 

3,427

 

  

 

   

 

 

Property and equipment

   10,120    10,301 

 

 

9,328

 

 

 

9,653

 

Less accumulated depreciation and amortization

   (4,186)    (4,162) 

 

 

(4,019

)

 

 

(4,045

)

  

 

   

 

 

Property and equipment, net

   5,934    6,139 

 

 

5,309

 

 

 

5,608

 

  

 

   

 

 

Goodwill

   4,494    4,559 

 

 

4,225

 

 

 

4,328

 

  

 

   

 

 

Deferred income taxes

   57    69 

 

 

107

 

 

 

38

 

  

 

   

 

 

Other assets, net

   2,163    1,543 

 

 

2,361

 

 

 

2,208

 

  

 

   

 

 

Total assets

  $16,132   $15,859 

 

$

16,415

 

 

$

15,609

 

  

 

   

 

 

LIABILITIES AND STOCKHOLDERS’ DEFICIT

    

 

 

 

 

 

 

 

 

Current liabilities:

    

 

 

 

 

 

 

 

 

Current maturities of long-term debt

  $206   $204 

 

$

30

 

 

$

20

 

Current operating lease liabilities

   133    - 

 

 

135

 

 

 

136

 

Accounts payable

   812    887 

 

 

677

 

 

 

811

 

Accrued liabilities:

    

 

 

 

 

 

 

 

 

Employee compensation

   549    627 

 

 

492

 

 

 

594

 

Accrued interest

   388    206 

 

 

211

 

 

 

189

 

Other

   415    468 

 

 

1,877

 

 

 

532

 

  

 

   

 

 

Total current liabilities

   2,503    2,392 

 

 

3,422

 

 

 

2,282

 

  

 

   

 

 

Long-term debt

   13,393    13,392 

 

 

13,106

 

 

 

13,385

 

  

 

   

 

 

Deferred income taxes

   26    26 

 

 

29

 

 

 

200

 

  

 

   

 

 

Long-term operating lease liabilities

   479    - 

 

 

508

 

 

 

487

 

  

 

   

 

 

Other long-term liabilities

   987    1,008 

 

 

913

 

 

 

894

 

  

 

   

 

 

Total liabilities

   17,388    16,818 

 

 

17,978

 

 

 

17,248

 

  

 

   

 

 

Redeemable noncontrolling interests in equity of consolidated subsidiaries

   503    504 

 

 

489

 

 

 

502

 

  

 

   

 

 

STOCKHOLDERS DEFICIT

    

Community Health Systems, Inc. stockholders deficit:

    

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; 118,051,975 shares issued and outstanding at June 30, 2019, and 116,248,376 shares issued and outstanding at December 31, 2018

   1    1 

STOCKHOLDERS’ DEFICIT

 

 

 

 

 

 

 

 

Community Health Systems, Inc. stockholders’ deficit:

 

 

 

 

 

 

 

 

Preferred stock, $.01 par value per share, 100,000,000 shares authorized; NaN issued

 

 

 

 

 

 

Common stock, $.01 par value per share, 300,000,000 shares authorized; 119,628,652

shares issued and outstanding at June 30, 2020, and 117,822,631 shares issued

and outstanding at December 31, 2019

 

 

1

 

 

 

1

 

Additionalpaid-in capital

   2,002    2,017 

 

 

2,008

 

 

 

2,008

 

Accumulated other comprehensive loss

   (8)    (10) 

 

 

(5

)

 

 

(9

)

Accumulated deficit

   (3,828)    (3,543) 

 

 

(4,131

)

 

 

(4,218

)

  

 

   

 

 

Total Community Health Systems, Inc. stockholders’ deficit

   (1,833)    (1,535) 

 

 

(2,127

)

 

 

(2,218

)

Noncontrolling interests in equity of consolidated subsidiaries

   74    72 

 

 

75

 

 

 

77

 

  

 

   

 

 

Total stockholders’ deficit

   (1,759)    (1,463) 

 

 

(2,052

)

 

 

(2,141

)

  

 

   

 

 

Total liabilities and stockholders’ deficit

  $16,132   $15,859 

 

$

16,415

 

 

$

15,609

 

  

 

   

 

 

See accompanying notes to the condensed consolidated financial statements.


4


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(In millions)

(Unaudited)

 

  Six Months Ended 

 

Six Months Ended

 

  June 30, 

 

June 30,

 

              2019                           2018             

 

2020

 

 

2019

 

Cash flows from operating activities:

    

 

 

 

 

 

 

 

 

Net loss

  $(246)   $(98) 

Adjustments to reconcile net loss to net cash provided by operating activities:

    

Net income (loss)

 

$

126

 

 

$

(246

)

Adjustments to reconcile net income (loss) to net cash provided by operating activities:

 

 

 

 

 

 

 

 

Depreciation and amortization

   305    358 

 

 

285

 

 

 

305

 

Deferred income taxes

 

 

(242

)

 

 

2

 

Government and other legal settlements and related costs

   9    7 

 

 

4

 

 

 

9

 

Stock-based compensation expense

   6    7 

 

 

5

 

 

 

6

 

Impairment and (gain) loss on sale of businesses, net

   71    202 

Loss (gain) from early extinguishment of debt

   31    (59) 

Impairment and loss on sale of businesses, net

 

 

56

 

 

 

71

 

Loss from early extinguishment of debt

 

 

4

 

 

 

31

 

Othernon-cash expenses, net

   101    23 

 

 

73

 

 

 

101

 

Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:

    

 

 

 

 

 

 

 

 

Patient accounts receivable

   (7)    (21) 

 

 

313

 

 

 

(7

)

Supplies, prepaid expenses and other current assets

   72    (15) 

 

 

21

 

 

 

72

 

Medicare accelerated payments

 

 

1,158

 

 

 

 

Unrecognized pandemic relief funds

 

 

116

 

 

 

 

Accounts payable, accrued liabilities and income taxes

   27    (308) 

 

 

(160

)

 

 

25

 

Other

   (104)    (2) 

 

 

(49

)

 

 

(104

)

  

 

   

 

 

Net cash provided by operating activities

   265    94 

 

 

1,710

 

 

 

265

 

  

 

   

 

 

Cash flows from investing activities:

    

 

 

 

 

 

 

 

 

Acquisitions of facilities and other related businesses

   (13)    (10) 

 

 

 

 

 

(13

)

Purchases of property and equipment

   (212)    (295) 

 

 

(192

)

 

 

(212

)

Proceeds from disposition of hospitals and other ancillary operations

   161    88 

 

 

152

 

 

 

161

 

Proceeds from sale of property and equipment

   1    4 

 

 

2

 

 

 

1

 

Purchases ofavailable-for-sale securities and equity securities

   (39)    (38) 

Proceeds from sales ofavailable-for-sale securities and equity securities

   52    63 

Purchases of available-for-sale debt securities and equity securities

 

 

(39

)

 

 

(39

)

Proceeds from sales of available-for-sale debt securities and equity securities

 

 

43

 

 

 

52

 

Increase in other investments

   (97)    (53) 

 

 

(19

)

 

 

(97

)

  

 

   

 

 

Net cash used in investing activities

   (147)    (241) 

 

 

(53

)

 

 

(147

)

  

 

   

 

 

Cash flows from financing activities:

    

 

 

 

 

 

 

 

 

Repurchase of restricted stock shares for payroll tax withholding requirements

   (1)    (1) 

 

 

(1

)

 

 

(1

)

Deferred financing costs and other debt-related costs

   (28)    (54) 

 

 

(32

)

 

 

(28

)

Proceeds from noncontrolling investors in joint ventures

   2    1 

 

 

 

 

 

2

 

Redemption of noncontrolling investments in joint ventures

   (2)    (6) 

 

 

(2

)

 

 

(2

)

Distributions to noncontrolling investors in joint ventures

   (57)    (52) 

 

 

(57

)

 

 

(57

)

Borrowings under credit agreements

   23    26 

Proceeds from sale-lease back

 

 

2

 

 

 

 

Other borrowings

 

 

31

 

 

 

23

 

Issuance of long-term debt

   2,034    - 

 

 

1,462

 

 

 

2,034

 

Proceeds from ABL facility

   25    587 

Proceeds from ABL Facility

 

 

540

 

 

 

25

 

Repayments of long-term indebtedness

   (2,103)    (709) 

 

 

(2,264

)

 

 

(2,103

)

  

 

   

 

 

Net cash used in financing activities

   (107)    (208) 

 

 

(321

)

 

 

(107

)

  

 

   

 

 

Net change in cash and cash equivalents

   11    (355) 

 

 

1,336

 

 

 

11

 

Cash and cash equivalents at beginning of period

   196    563 

 

 

216

 

 

 

196

 

  

 

   

 

 

Cash and cash equivalents at end of period

  $207   $208 

 

$

1,552

 

 

$

207

 

  

 

   

 

 

Supplemental disclosure of cash flow information:

    

 

 

 

 

 

 

 

 

Interest payments

  $(318)   $(486) 

 

$

(486

)

 

$

(318

)

  

 

   

 

 

Income tax refunds (payments), net

  $3   $9 

 

$

2

 

 

$

3

 

  

 

   

 

 

See accompanying notes to the condensed consolidated financial statements.

5


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

1.

1.  BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

The unaudited condensed consolidated financial statements of Community Health Systems, Inc. (the “Parent” or “Parent Company”) and its subsidiaries (the “Company”) as of June 30, 20192020 and December 31, 20182019 and for the three-month andsix-month periods ended June 30, 20192020 and 2018,2019, 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 six months ended June 30, 2019,2020, are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2019. 2020. 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.

Certain information and disclosures normally included in the notes to condensedthe 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, 2018,2019, contained in the Company’s Annual Report on Form10-K filed with the SEC on February 21, 20, 2020 (“2019 (“2018 Form10-K”). Certain prior period amounts have been reclassified to conform to the current period presentation within the condensed consolidated statements of cash flows.

During the first quarter of 2020, the Company early adopted the SEC’s Financial Disclosures About Guarantors and Issuers of Guaranteed Securities and Affiliates Whose Securities Collateralize a Registrant’s Securities rules, which simplify the disclosure requirements related to the Company’s registered debt securities under Rule 3-10 of Regulation S-X (see Note 15).

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.

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 include the Company’s corporate office costs at its Franklin, Tennessee office, which were $57 million and $43 million for the three months ended June 30, 2020 and 2019, respectively, and $95 million and $86 million for the six months ended June 30, 2020 and 2019, respectively. Included in these corporate office costs is stock-based compensation of$3 million for both of the three-month periods ended June 30, 2020 and 2019, and $5 million and $6 million for the six months ended June 30, 2020 and 2019, respectively.

Throughout these notes to the condensed consolidated financial statements, Community Health Systems, Inc., 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 particular 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 by distinct and indirect subsidiaries of Community Health Systems, Inc.

Revenue Recognition.On January 1, 2018, the Company adopted the new revenue recognition accounting standard issued by the Financial Accounting Standards Board (“FASB”) and codified in the FASB Accounting Standards Codification (“ASC”) as topic 606 (“ASC 606”). The revenue recognition standard in ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Company’s revenue recognition policies and significant judgments employed in the determination of revenue.

The Company applied the modified retrospective approach to all contracts when adopting ASC 606. As a result, upon the Company’s adoption of ASC 606 the majority of what was previously classified as the provision for bad debts in the statement of operations is now reflected as implicit price concessions (as defined in ASC 606) and therefore is included as a reduction to net operating revenues. For changes in credit issues not assessed at the date of service, the Company prospectively recognizes those amounts in other operating expenses on the statement of operations. Other than these changes in presentation on the consolidated statement of operations, the adoption of ASC 606 did not have a material impact on the consolidated results of operations for the year ended December 31, 2018 or the six months ended June 30, 2019, and the Company does not expect it to have a material impact on its consolidated results of operations on a prospective basis.

As part of the adoption of ASC 606, the Company elected two of the available practical expedients provided for in the standard. First, the Company does not adjust the transaction price for any financing components as those were deemed to be insignificant. Additionally, the Company expenses all incremental customer contract acquisition costs as incurred because such costs are not material and would be amortized over a period less than one year.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Net Operating Revenues

Net operating revenues are recorded at the transaction price estimated by the Company to reflect the total consideration due from patients and third-party payors in exchange for providing goods and services in patient care. These services are considered to be a single performance obligation and have a duration of less than one year. Revenues are recorded as these goods and services are provided. The transaction price, which involves significant estimates, is determined based on the Company’s standard charges for the goods and services provided, with a reduction recorded for price concessions related to third party contractual arrangements as well as patient discounts and other patient price concessions. During the year ended December 31, 2018 andeach of the three and six monthsmonth periods ended June 30, 2020 and June 30, 2019, the impact of changes to the inputs used to determine the transaction price was considered immaterial to the current period.immaterial.

6


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

Currently, several states utilize supplemental reimbursement programs for the purpose of providing reimbursement to providers that is not specifically tied to offset an individual’s care, some of which offsets a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed with input from the Centers for Medicare & Medicaid Services (“CMS”) and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. Under these supplemental programs, the Company recognizes 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 fees, taxes or other program-related costs are reflected in other operating expenses.

The Company’s net operating revenues during the three and six months ended June 30, 20192020 and 20182019 have been presented in the following table based on an allocation of the estimated transaction price with the patient between the primary patient classification of insurance coverage (in millions):

 

  Three Months Ended   Six Months Ended 

 

Three Months Ended

 

 

Six Months Ended

 

  June 30,   June 30, 

 

June 30,

 

 

June 30,

 

          2019                   2018                   2019                   2018         

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Medicare

  $819   $943   $1,708   $1,977 

 

$

607

 

 

$

819

 

 

$

1,363

 

 

$

1,708

 

Medicaid

   452    479    880    938 

 

 

341

 

 

 

452

 

 

 

748

 

 

 

880

 

Managed Care and other third-party payors

   1,993    2,110    4,019    4,227 

 

 

1,626

 

 

 

1,993

 

 

 

3,458

 

 

 

4,019

 

Self-pay

   38    30    72    109 

 

 

(55

)

 

 

38

 

 

 

(25

)

 

 

72

 

  

 

   

 

   

 

   

 

 

Total

  $3,302   $3,562   $6,679   $7,251 

 

$

2,519

 

 

$

3,302

 

 

$

5,544

 

 

$

6,679

 

  

 

   

 

   

 

   

 

 

Patient Accounts Receivable

Patient accounts receivable are recorded at net realizable value based on certain assumptions determined by each payor. For third-party payors including Medicare, Medicaid, and Managed Care, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. Forself-pay accounts receivable, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience without regard to aging category. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.  

Patient accounts receivable can be impacted by the effectiveness of the Company’s collection efforts. Additionally, significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect the net realizable value of accounts receivable. The Company also continually reviews the net realizable value of accounts receivable by monitoring historical cash collections as a percentage of trailing net operating revenues, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding, the composition ofself-pay receivables between pureself-pay patients and the patient responsibility portion of third-party insured receivables and the impact of recent acquisitions and dispositions.

Final settlements for some payors and programs are subject to adjustment based on administrative review and audit by third parties. As a result of these final settlements, the Company has recorded amounts due to third-party payors of $129$81 million and $144$83 million as of June 30, 20192020 and December 31, 2018,2019, respectively, and these amounts are included in accrued liabilities-other in the accompanying condensed consolidated balance sheets. Amounts due from third-party payors were $136$124 million and $155$137 million as of June 30, 20192020 and December 31, 2018,2019, respectively, and are included in other current assets in the accompanying condensed consolidated balance sheets. Substantially all Medicare and Medicaid cost reports are final settled through 2015.

2016.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Charity Care

In the ordinary course of business, the Company renders services to patients who are financially unable to pay for hospital care. The Company’s policy is to not pursue collections for such amounts; therefore, the related charges for those patients who are financially unable to pay and that otherwise do not qualify for reimbursement from a governmental program are not reported in net operating revenues, and are thus classified as charity care. The Company determines amounts that qualify for charity care primarily based on the patient’s household income relative to the federal poverty level guidelines, as established by the federal government.

7


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

These charity care services are estimated to be $142$138  million and $115$142 million for the three months ended June 30, 20192020 and 2018,2019, respectively, and $284$304 million and $229$284 million for the six months ended June 30, 20192020 and 2018,2019, respectively, representing the value (at the Company’s standard charges) of these charity care services that are excluded from net operating revenues. The estimated cost incurred by the Company to provide these charity care services to patients who are unable to pay was approximately $18$17 million and $14$18 million during the three months ended June 30, 20192020 and 2018,2019, respectively, and $33$36 million and $28$33 million during the six months ended June 30, 20192020 and 2018,2019, respectively. The estimated cost of these charity care services was determined using a ratio of cost to gross charges and applying that ratio to the gross charges associated with providing care to charity patients for the period.

Leases.On January 1, 2019, the Company adopted the cumulative accounting standard updates initially issued by the FASB in February 2016 that amend the accounting for leases and are codified as ASC 842. These changes to the lease accounting model require operating leases be recorded on the balance sheet through recognition of a liability for the discounted present value of future fixed lease payments and a correspondingright-of-use (“ROU”) asset. The Company’s accounting for finance leases remained substantially unchanged from its prior accounting for capital leases. The ROU asset recorded at commencement of the lease represents the right to use the underlying asset over the lease term in exchange for the lease payments. Leases with an initial term of 12 months or less that do not have an option to purchase the underlying asset that is deemed reasonably certain to be exercised are not recorded on the balance sheet; rather, rent expense for these leases is recognized on a straight-line basis over the lease term, or when incurred if amonth-to-month lease. When readily determinable, the Company uses the interest rate implicit in a lease to determine the present value of future lease payments. For leases where the implicit rate is not readily determinable, the Company’s incremental borrowing rate is utilized. The Company calculates its incremental borrowing rate on a quarterly basis using a third-party financial model that estimates the rate of interest the Company would have to pay to borrow an amount equal to the total lease payments on a collateralized basis over a term similar to the lease. Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.

The Company elected the amended transition requirements allowed for by the FASB in Accounting Standards Update (“ASU”)2018-11, which provide entities relief by allowing them not to recast prior comparative periods from the adoption of ASC 842. As a result, the prior year comparative financial statements have not been restated to reflect the adoption of ASC 842. Additionally, the Company elected the package of practical expedients available in ASC 842 upon adoption whereby an entity need not reassess expired contracts for lease identification or classification as a finance or operating lease, or for the reassessment of initial direct costs. The Company has not elected the practical expedient to use hindsight to determine the lease term for its leases at transition. Certain of the Company’s lease agreements have lease andnon-lease components, which for the majority of leases the Company accounts for separately when the actual lease andnon-lease components are determinable. For equipment leases with immaterialnon-lease components incorporated into the fixed rent payment, the Company accounts for the lease andnon-lease components as a single lease component in determining the lease payment. Additionally, for certain individually insignificant equipment leases such as copiers, the Company applies a portfolio approach to effectively record the operating lease liability and ROU asset.

The adoption of ASC 842 had a material impact on the Company’s condensed consolidated balance sheet through the recording of the operating lease liabilities and related ROU assets for leases in effect at January 1, 2019, but the adoption did not have a material impact on the Company’s condensed consolidated statement of loss or condensed consolidated statement of cash flows for the six months ended June 30, 2019. The Company recorded approximately $673 million of operating lease liabilities and ROU assets on January 1, 2019 upon adoption of ASC 842, with no impact on accumulated deficit.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Accounting for the Impairment or Disposal of Long-Lived Assets.    During the six months ended June 30, 2020, the Company recorded a total combined net impairment charge and loss on disposal of approximately $56 million, of which approximately $64 million was recorded to adjust the carrying value of long-lived assets at several hospitals where the Company is in discussions with potential buyers for divestiture at a sales price that indicates a fair value below carrying value. Approximately $13 million was recorded related to certain hospitals that have been classified as held for sale based on the difference between the carrying value of the hospital disposal groups compared to their estimated fair value less costs to sell. The impairment charge was partially offset by a gain of approximately $21 million related to 3 hospitals sold on January 1, 2020 and 2 hospitals sold on May 1, 2020. During the six months ended June 30, 2020, a net allocation of approximately $103 million of goodwill was allocated from the hospital operations reporting unit based on a calculation of each disposal groups’ relative fair value compared to the total reporting unit. The Company will continue to evaluate the potential for further impairment of the long-lived assets of underperforming hospitals as well as evaluate offers for potential sales. Based on such analysis, additional impairment charges may be recorded in the future.

During the six months ended June 30, 2019, the Company recorded a total combined impairment charge and loss on disposal of approximately $71 million to reduce the carrying value of closed hospitals and certain hospitals that have been deemed held for sale based on the difference between the carrying value of the hospital disposal groups compared to estimated fair value less costs to sell. Included in the carrying value of the hospital disposal groups at June 30, 2019 is a net allocation of approximately $68 million of goodwill allocated from the hospital operations reporting unit goodwill based on a calculation of the disposal groups’ relative fair value compared to the total reporting unit. The Company will continue to evaluate

COVID-19 Pandemic.

In January 2020, the potential for further impairmentSecretary of the long-lived assetsU.S. Department of underperforming hospitals as well as evaluate offers for potential sales. Based on such analysis, additional impairment charges may be recorded inHealth and Human Services (“HHS”) declared a national public health emergency due to a novel strain of coronavirus. In March 2020, the future.

DuringWorld Health Organization declared the outbreak of COVID-19, a disease caused by this coronavirus, a pandemic. The resulting measures to contain the spread and impact of COVID-19 have adversely affected the Company’s results of operations. Where applicable, the impact resulting from the COVID-19 pandemic during the three and six months ended June 30, 2018,2020, has been considered, including updated assessments of the recoverability of assets and evaluation of potential credit losses. As a result of the COVID-19 pandemic, federal and state governments have passed legislation, promulgated regulations and taken other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients during the public health emergency. Sources of relief include the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”), which was enacted on March 27, 2020, and the Paycheck Protection Program and Health Care Enhancement Act (the “PPPHCE Act”), which was enacted on April 24, 2020. Together, the CARES Act and the PPPHCE Act include $175 billion in funding to be distributed to eligible providers through the Public Health and Social Services Emergency Fund (the “PHSSEF”). In addition, the CARES Act provides for an expansion of the Medicare Accelerated and Advance Payment Program whereby inpatient acute care hospitals and other eligible providers may request accelerated payment of up to 100% of their Medicare payment amount for a six-month period to be repaid through withholding of future Medicare fee-for-service payments beginning 120 days after receipt. During the three and six-month periods ended June 30, 2020, the Company recordedwas the beneficiary of these stimulus measures, including the Medicare Accelerated and Advance Payment Program. The Company’s accounting policies for the recognition of these stimulus monies is as follows:

CARES Act and PPPHCE Act Funds

During the three months ended June 30, 2020, the Company received approximately $564 million in payments through the PHSSEF in both general and targeted distributions, net of amounts received for previously divested entities that are required to be repaid to HHS. Approximately $448 million of the PHSSEF payments qualified as reimbursement for lost revenues and incremental expenses and was recognized as a total combined impairment chargereduction to operating costs and loss on disposalexpenses during the three and six months ended June 30, 2020, which is denoted by the caption “pandemic relief funds” within the condensed consolidated statements of income (loss). The recognition of amounts received is conditioned upon the provision of care for individuals with possible or actual cases of COVID-19 after January 31, 2020, certification that payment will be used to prevent, prepare for and respond to coronavirus and shall reimburse the recipient only for healthcare related expenses or lost revenues that are attributable to coronavirus, and receipt of the funds. Amounts are recognized as a reduction to operating costs and expenses only to the extent the Company is reasonably assured that

8


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

underlying conditions are met. Amounts not recognized as a reduction to operating costs and expenses or that have not been refunded to HHS as of June 30, 2020, are reflected within accrued liabilities-other in the condensed consolidated balance sheet, and such unrecognized amounts may be recognized as a reduction in operating costs and expenses in future periods if the underlying conditions for recognition are met. As further discussed in Note 14, the Company has received distributions from the PHSSEF in July 2020 totaling approximately $109 million, which did not qualify for recognition as a reduction to operating costs and expenses during the three months ended June 30, 2020.

Medicare Accelerated Payments

Medicare accelerated payments of approximately $202 million$1.2 billion were received by the Company during the three months ended June 30, 2020. These are advances that must be repaid. The Medicare accelerated payments are interest free for up to reduce12 months and the carrying valueprogram currently requires that CMS recoup the accelerated payments beginning 120 days after receipt by the provider, by withholding future Medicare fee-for-service payments for claims until such time as the full accelerated payment has been recouped. The program currently requires that any outstanding balance remaining after 12 months must be repaid by the provider or be subjected to a 10.25% annual interest rate. Effective April 26, 2020, CMS is reevaluating pending and new applications for accelerated payments in light of certain hospitals that have been deemed held for sale based onsignificant other relief provided by the difference betweenCARES Act and the carrying valuePPPHCE Act. Accordingly, the Company does not expect to receive additional Medicare accelerated payments. Recoupment of accelerated payments received by the hospital disposal groups comparedCompany is currently expected to estimated fair value less costs to sell. Includedbegin in August 2020. As of June 30, 2020, Medicare accelerated payments are reflected within accrued liabilities-other in the carrying value of the hospital disposal groups at June 30, 2018 is a net allocation of approximately $77 million of goodwill allocated from the hospital operations reporting unit goodwill based on a calculation of the disposal groups’ relative fair value compared to the total reporting unit.condensed consolidated balance sheet.

New Accounting Pronouncements.    In August 2018,March 2020, the FASB issued Accounting Standards Update (“ASU”) 2020-04, “Reference Rate Reform: Facilitation of the Effects of Reference Rate Reform on Financial Reporting.” This ASU2018-15 provides optional expedients and exceptions for applying GAAP to provide guidance oncontract modifications and hedging relationships, subject to meeting certain criteria that reference the accounting for implementation costs incurred in a cloud computing arrangementLondon Interbank Offered Rate (“LIBOR”) or another rate that is accounted for as a service contract. Thisexpected to be discontinued. The amendments in the ASU requires entities to account for such costs consistent with the guidance on capitalizing costs associated with developing or obtaininginternal-use software. The ASU isare effective for all entities for fiscal years beginning afteras of March 12, 2020 through December 15, 2019, and interim periods within those fiscal years, with early adoption permitted.31, 2022. The Company is currently evaluating the impact that adoption of this ASU willguidance did not have a material impact on itsthe Company’s condensed consolidated financial position or results of operations.

The Company has evaluated all other recently issued, but not yet effective, ASUs and does not expect the eventual adoption of these ASUs to have a material impact on its condensed consolidated financial position or results of operations.

2.  ACCOUNTING FOR STOCK-BASED COMPENSATION

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. Amended and Restated 2009 Stock Option and Award Plan, which was amended and restated as of March 14, 201820, 2020 and approved by the Company’s stockholders at the annual meeting of stockholders held on May 15, 2018 (the12, 2020 (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 did 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 included the Company’s directors, officers, employees and consultants. All options granted under the 2000 Plan were “nonqualified” stock options for tax purposes. Generally, vesting of these granted options occurred inone-third increments on each of the first three anniversaries of the award date. Options granted prior to 2005 had a10-year contractual term, options granted in 2005 through 2007 had an eight-year contractual term and options granted since 2008 had a10-year contractual term. Pursuant to the amendment and restatement of the 2000 Plan dated March 20, 2013, 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 inone-third increments on each of the first three anniversaries of the award date. Options granted in 2011 or later have a10-year contractual term. As of June 30, 2019, 4,970,5002020, 10,384,418 shares of unissued common stock were reserved for future grants under the 2009 Plan.

The exercise price of all options granted under the 2000 Plan and the 2009 Plan has beenis equal to the fair value of the Company’s common stock on the option grant date.

9


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

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 millions):

 

  Three Months Ended   Six Months Ended 

 

Three Months Ended

 

 

Six Months Ended

 

  June 30,   June 30, 

 

June 30,

 

 

June 30,

 

        2019               2018               2019               2018       

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Effect on loss before income taxes

  $(3)   $(3)   $(6)   $(7) 

 

$

(3

)

 

$

(3

)

 

$

(5

)

 

$

(6

)

  

 

   

 

   

 

   

 

 

Effect on net loss

  $(2)   $(2)   $(4)   $(4) 
  

 

   

 

   

 

   

 

 

Effect on net income (loss)

 

$

(2

)

 

$

(2

)

 

$

(4

)

 

$

(4

)

At June 30, 2019, $192020, $21 million of unrecognized stock-based compensation expense related to outstanding unvested stock options, restricted stock and restricted stock units (the terms of which are summarized below) was expected to be recognized over a weighted-average period of 26 months. Of that amount, $2$3 million related to outstanding unvested stock options was expected to be recognized over a weighted-average period of 3228 months and $17$18 million related to outstanding unvested restricted stock and restricted stock units was expected to be recognized over a weighted-average period of 2526 months. There were no0 modifications to awards during the three or six months ended June 30, 20192020 and 2018.2019.

The fair value of stock options was estimated using the Black Scholes option pricing model with the following assumptions and weighted-average fair values during the three and six months ended June 30, 2020 and 2019:

 

          Three Months Ended                   Six Months Ended         

 

Three Months Ended

June 30,

 

 

Six Months Ended

June 30,

 

  June 30, 2019   June 30, 2019 

 

2020

 

2019

 

 

2020

 

 

2019

 

Expected volatility

   67.5 %      68.4 %   

 

N/A

 

 

67.5

%

 

 

73.5

%

 

 

68.4

%

Expected dividends

   -          -       

 

N/A

 

 

 

 

 

 

 

 

 

Expected term

   6 years          5.6 years       

 

N/A

 

6.0 years

 

 

6 years

 

 

5.6 years

 

Risk-free interest rate

   1.9 %      2.6 %   

 

N/A

 

 

1.9

%

 

 

1.0

%

 

 

2.6

%

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 discernable employee populations. From this analysis, the Company identified two primary employee populations, one consisting of certain senior executives and the other 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. Thepre-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.

10


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Options outstanding and exercisable under the 2000 Plan and the 2009 Plan as of June 30, 2019,2020, and changes during each of the three-month periods following December 31, 2018, were2019, was as follows (in millions, except share and per share data):

 

 

 

 

 

 

 

 

 

 

Weighted-

 

Aggregate

 

          Weighted-   Aggregate 

 

 

 

 

 

Weighted-

 

 

Average

 

Intrinsic

 

          Average   Intrinsic 

 

 

 

 

 

Average

 

 

Remaining

 

Value as of

 

      Weighted-   Remaining       Value as of     

 

 

 

 

 

Exercise

 

 

Contractual

 

June 30,

 

      Average   Contractual   June 30, 

 

Shares

 

 

Price

 

 

Term

 

2020

 

          Shares               Exercise Price                 Term             2019 

Outstanding at December 31, 2018

   624,938    $31.21      

Outstanding at December 31, 2019

 

 

1,110,134

 

 

 

16.90

 

 

5.6 years

 

 

 

 

Granted

   646,500     4.99      

 

 

946,500

 

 

 

4.93

 

 

 

 

 

 

 

Exercised

            

 

 

 

 

 

 

 

 

 

 

 

 

Forfeited and cancelled

   (92,301)    25.57      

 

 

(159,938

)

 

 

33.90

 

 

 

 

 

 

 

  

 

       

Outstanding at March 31, 2019

   1,179,137     17.27      

Outstanding at March 31, 2020

 

 

1,896,696

 

 

 

9.50

 

 

 

 

 

 

 

Granted

   12,000     2.66      

 

 

 

 

 

 

 

 

 

 

 

 

Exercised

            

 

 

 

 

 

 

 

 

 

 

 

 

Forfeited and cancelled

   (30,834)    31.94      

 

 

(31,667

)

 

 

31.90

 

 

 

 

 

 

 

  

 

       

Outstanding at June 30, 2019

   1,160,303    $16.73     6.2 years   $- 
  

 

   

 

   

 

   

 

 

Exercisable at June 30, 2019

   501,803    $32.20     1.5 years   $- 
  

 

   

 

   

 

   

 

 

Outstanding at June 30, 2020

 

 

1,865,029

 

 

$

9.12

 

 

8.0 years

 

$

 

Exercisable at June 30, 2020

 

 

502,525

 

 

$

20.45

 

 

4.2 years

 

$

 

NaN stock options were granted during the three months ended June 30, 2020. The weighted-average grant date fair value of stock options granted during the three and six months ended June 30, 2019 was $1.63, and $2.36, respectively. No stock options were granted during the three and six months ended June 30, 2018.2020 and 2019 was $3.17 and $2.36, respectively. The aggregate intrinsic value (calculated as the number ofin-the-money stock options multiplied by the difference between the Company’s closing stock price on the last trading day of the reporting period ($2.67)3.01) 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 June 30, 2019.2020. This amount changes based on the market value of the Company’s common stock. There were no0 options exercised during the three or six months ended June 30, 20192020 and 2018.2019. 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 2009 Plan to employees of certain subsidiaries. With respect to time-based vesting restricted stock that has been awarded under the 2009 Plan, the restrictions on these shares have generally lapsed inone-third increments on each of the first three anniversaries of the award date. In addition, certain of the restricted stock awards granted to the Company’s senior executives have contained performance objectives required to be met in addition to any time-based vesting requirements. If the applicable performance objectives are not attained, these awards will be forfeited in their entirety. For such performance-based awards granted prior to March 1, 2017, performance objectives were measured over aone-year period, and, provided the target performance objective was attained, restrictions lapsed inone-third increments on each of the first three anniversaries of the award date. For performance-based awards granted on or after March 1, 2017, the performance objectives have been measured cumulatively over a three-year period. With respect to performance-based awards granted on or after March 1, 2017, if the applicable target performance objective is met at the end of the three-year period, then the portion of the restricted stock award subject to such performance objective will vest in full on the third anniversary of the award date. Additionally, for these performance-based awards, based on the level of achievement for the applicable performance objective within the parameters specified in the award agreement, the number of shares to be issued in connection with the vesting of the award may be adjusted to decrease or increase the number of shares specified in the original award. Notwithstanding the above-mentioned performance objectives and vesting requirements, the restrictions with respect to restricted stock granted under the 2009 Plan may 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. The entire restricted stock awards subject to performance objectives granted on March 1, 2017 were forfeited during the six months ended June 30, 2020 as a result of the minimum level of the applicable cumulative performance objectives for the 2017-2019 performance period not having been met. Restricted stock awards subject to performance objectives that have not yet been satisfied are not considered outstanding for purposes of determining earnings per share until the performance objectives have been satisfied.

11


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Restricted stock outstanding under the 2009 Plan as of June 30, 2019,2020, and changes during each of the three-month periods following December 31, 2018, were2019, was as follows:

 

 

 

 

 

 

Weighted-

 

      Weighted- 

 

 

 

 

 

Average Grant

 

      Average Grant 

 

Shares

 

 

Date Fair Value

 

              Shares                   Date Fair Value     

Unvested at December 31, 2018

   3,308,907    $7.00  

Unvested at December 31, 2019

 

 

3,857,402

 

 

$

5.47

 

Granted

   1,958,000     4.97  

 

 

2,197,500

 

 

 

4.90

 

Vested

   (983,986)    9.17  

 

 

(988,650

)

 

 

5.77

 

Forfeited

   (57,335)    6.37  

 

 

(328,500

)

 

 

9.19

 

  

 

   

Unvested at March 31, 2019

   4,225,586     5.56  

Unvested at March 31, 2020

 

 

4,737,752

 

 

 

4.89

 

Granted

   17,000     2.66  

 

 

4,000

 

 

 

3.19

 

Vested

   (62,665)    8.52  

 

 

(96,677

)

 

 

6.81

 

Forfeited

   (19,334)    4.72  

 

 

(26,335

)

 

 

5.00

 

  

 

   

Unvested at June 30, 2019

   4,160,587     5.51  
  

 

   

Unvested at June 30, 2020

 

 

4,618,740

 

 

 

4.84

 

Restricted stock units (“RSUs”) have been granted to the Company’s outsidenon-management directors under the 2000 Plan and the 2009 Plan. On March 1, 2018, eachEach of the Company’s outsidethen serving non-management directors received a grant under the 2009 Plan of 37,118 RSUs. On March 1, 2019, each of the Company’s outside directors received a grantgrants under the 2009 Plan of 34,068 RSUs.RSUs and 34,483 RSUs on March 1, 2019 and 2020, respectively. Each of the 20182019 and 20192020 grants had a grant date fair value of approximately $170,000. Vesting of these RSUs occurs inone-third increments on each of the first three anniversaries of the award date or upon the director’s earlier cessation of service on the board, other than for cause. Beginning with the 2020 grant, each non-management director may elect, prior to the beginning of the calendar year in which the award is granted, to defer the receipt of shares of the Company’s common stock issuable upon vesting until either his or her (i) separation from service with the Company or (ii) attainment of an age specified in advance by the non-management director.

RSUs outstanding under the 2009 Plan as of June 30, 2019,2020, and changes during each of the three-month periods following December 31, 2018, were2019, was as follows:

 

 

 

 

 

 

Weighted-

 

      Weighted- 

 

 

 

 

 

Average Grant

 

      Average Grant 

 

Shares

 

 

Date Fair Value

 

              Shares                   Date Fair Value     

Unvested at December 31, 2018

   397,906    $6.17  

Unvested at December 31, 2019

 

 

541,576

 

 

$

5.13

 

Granted

   306,612     4.99  

 

 

310,347

 

 

 

4.93

 

Vested

   (162,942)    7.42  

 

 

(238,184

)

 

 

5.47

 

Forfeited

        

 

 

 

 

 

 

  

 

   

Unvested at March 31, 2019

   541,576     5.13  

Unvested at March 31, 2020

 

 

613,739

 

 

 

4.89

 

Granted

        

 

 

 

 

 

 

Vested

        

 

 

 

 

 

 

Forfeited

        

 

 

 

 

 

 

  

 

   

Unvested at June 30, 2019

   541,576     5.13  
  

 

   

Unvested at June 30, 2020

 

 

613,739

 

 

 

4.89

 

 

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 $43 million for both of the three-month periods ended June 30, 2019 and 2018, and $86 million and $95 million for the six months ended June 30, 2019 and 2018, respectively. Included in these corporate office costs is stock-based compensation of $3 million for both of the three-month periods ended June 30, 2019 and 2018, and $6 million and $7 million for the six months ended June 30, 2019 and 2018, respectively.3.  ACQUISITIONS AND DIVESTITURES

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.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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 when identified. 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.

12


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

Acquisition and integration expenses related to prospective and closed acquisitions included in other operating expenses on the condensed consolidated statements of lossincome (loss) were $2less than $1 million and less than $1approximately $2 million for the three months ended June 30, 20192020 and 2018,2019, respectively, and $3less than $1 million and $1approximately $3 million for the six months ended June 30, 20192020 and 2018,2019, respectively.

During the six months ended June 30, 2019,2020, one or more subsidiaries of the Company paid approximately $7less than $1 million to acquire the operating assets and related businesses of certain physician practices, clinics and other ancillary businesses that operate within the communities served by the Company’s affiliated hospitals. In connection with these acquisitions, during the six months ended June 30, 2019, theThe Company allocated approximately $4 million of the consideration paidpurchase price to property and equipment, and net working capital and the remainder, approximately $3 million consisting of intangible assets that do not qualify for separate recognition, to goodwill.

Effective June 1, 2019, one or more subsidiaries of the Company completed the acquisition of Northwest Mississippi Medical Center in Clarksdale, Mississippi. This healthcare system includes 181 licensed beds and other outpatient and ancillary services. The total cash consideration paid for operating assets was approximately $2 million with additional consideration of $5 million in assumed liabilities, for a total consideration of $7 million. This hospital was acquired in conjunction with the bankruptcy proceedings for the previous owner that acquired the hospital from the Company in 2017 as part of an agreement with the local county government associated with its lease of the hospital building. Based on the current purchase price allocation relating to this acquisition, no goodwill has been recorded. Prior to the completion of the acquisition, the Company initiated a plan to sell this hospital and as such has classified this hospital as held for sale at June 30, 2019.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Divestitures

The following table provides a summary of hospitals that the Company divested during the six months ended June 30, 20192020 and the year ended December 31, 2018:2019:

 

Licensed

Licensed

Hospital

Buyer

City, State

Beds

Effective Date

2020 Divestitures:

2019 Divestitures:

Shands Live Oak Regional Medical Center

HCA Healthcare, Inc. (HCA”)

Live Oak, FL

25

May 1, 2020

Shands Starke Regional Medical Center

HCA

Starke, FL

49

May 1, 2020

Southside Regional Medical Center

Bon Secours Mercy Health System

Petersburg, VA

300

January 1, 2020

Southampton Memorial Hospital

Bon Secours Mercy Health System

Franklin, VA

105

January 1, 2020

Southern Virginia Regional Medical Center

Bon Secours Mercy Health System

Emporia, VA

80

January 1, 2020

2019 Divestitures:

Bluefield Regional Medical Center

Princeton Community Hospital Association

Bluefield, WV

92

October 1, 2019

Lake Wales Medical Center

Adventist Health System

Lake Wales, FL

160

September 1, 2019

Heart of Florida Regional Medical Center

Adventist Health System

Davenport, FL

193

September 1, 2019

College Station Medical Center

St. Joseph Regional Health Center

College Station, TX

167

August 1, 2019

Tennova Healthcare - Lebanon

Vanderbilt University Medical Center

Lebanon, TN

245

August 1, 2019

Chester Regional Medical Center

Medical University Hospital Authority

Chester, SC

82

82

March 1, 2019

Carolinas Hospital System - Florence

Medical University Hospital Authority

Florence, SC

396

396

March 1, 2019

Springs Memorial Hospital

Medical University Hospital Authority

Lancaster, SC

225

225

March 1, 2019

Carolinas Hospital System - Marion

Medical University Hospital Authority

Mullins, SC

124

124

March 1, 2019

Memorial Hospital of Salem County

Community Healthcare Associates, LLC

Salem, NJ

126

126

January 31, 2019

Mary Black Health System - Spartanburg

Spartanburg Regional Healthcare System

Spartanburg, SC

207

207

January 1, 2019

Mary Black Health System - Gaffney

Spartanburg Regional Healthcare System

Gaffney, SC

125

125

January 1, 2019

2018 Divestitures:

Sparks Regional Medical CenterBaptist HealthFort Smith, AR492November 1, 2018
Sparks Medical Center - Van BurenBaptist HealthVan Buren, AR103November 1, 2018
AllianceHealth DeaconessINTEGRIS HealthOklahoma City, OK238October 1, 2018
Munroe Regional Medical CenterAdventist Health SystemOcala, FL425August 1, 2018
Tennova Healthcare - Dyersburg RegionalWest Tennessee HealthcareDyersburg, TN225June 1, 2018
Tennova Healthcare - Regional JacksonWest Tennessee HealthcareJackson, TN150June 1, 2018
Tennova Healthcare - Volunteer MartinWest Tennessee HealthcareMartin, TN100June 1, 2018
Williamson Memorial HospitalMingo Health Partners, LLCWilliamson, WV76June 1, 2018
Byrd Regional HospitalAllegiance Health ManagementLeesville, LA60June 1, 2018
Tennova Healthcare - JamestownRennova

On March 18, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of substantially all of the assets of Northern Louisiana Medical Center (130 licensed beds) in Ruston, Louisiana to affiliates of Allegiance Health Management, Inc. This disposition was completed on July 1, 2020, as further described in Note 14 below.

On April 20, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of substantially all of the assets of San Angelo Community Medical Center (171 licensed beds) in San Angelo, Texas to affiliates of Shannon Health System.

On April 27, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of substantially all of the assets of each of Abilene Regional Medical Center (231 licensed beds) in Abilene, Texas and Brownwood Regional Medical Center (188 licensed beds) in Brownwood, Texas to subsidiaries of Hendrick Health System.

13


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

On April 27, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of the majority ownership interest in St. Cloud Regional Medical Center (84 licensed beds) in St. Cloud, Florida to affiliates of Orlando Health, Inc., who already hold the minority ownership interest. This disposition was completed on July 1, 2020, as further described in Note 14 below.

On May 28, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of the Company’s ownership interest in Hill Regional Hospital (25 licensed beds) in Hillsboro, Texas to AHRK Holdings, LLC.

On June 25, 2020, one or more affiliates of the Company entered into a definitive agreement for the sale of substantially all the assets of Bayfront Health St. Petersburg (480 licensed beds) in St. Petersburg, Florida to affiliates of Orlando Health, Inc.Jamestown, TN85June 1, 2018Bayfront Health Dade CityAdventist Health SystemDade City, FL120April 1, 2018

A discontinued operation in U.S. GAAP is a disposal that represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results. Additional disclosures are required for significant components of the entity that are disposed of or are held for sale but do not qualify as discontinued operations. The divestitures above do not meet the criteria for reporting as discontinued operations and are included in continuing operations for the six months ended June 30, 2019 and 2018.

The following table discloses amounts included in the condensed consolidated balance sheetsheets for the hospitals classified as held for sale as of June 30, 20192020 and December 31, 20182019 (in millions):. Other assets, net primarily includes the net property and equipment for hospitals held for sale. No divestitures or potential divestitures meet the criteria for reporting as a discontinued operation.

 

            June 30, 2019                   December 31, 2018       

 

June 30,

2020

 

 

December 31,

2019

 

Other current assets

  $23    $21  

 

$

52

 

 

$

25

 

Other assets, net

   213     154  

 

 

453

 

 

 

262

 

Accrued liabilities

   28     44  

 

 

128

 

 

 

43

 

Other Hospital Closures

During the three months ended June 30, 2020, one or more affiliates of the Company entered into a settlement and termination agreement with the Lake Shore Hospital Authority for the planned closure of the Shands Lake Shore Regional Medical Center in Lake City, Florida. The closure is currently expected to be completed by August 31, 2020. An immaterial adjustment was recorded during the three months ended June 30, 2020 to adjust the supplies, inventory and long-lived assets to fair value.

During the three months ended December 31, 2018, the Company completed the planned closure of Tennova – Physicians Regional Medical Center in Knoxville, Tennessee and Tennova – Lakeway Regional Medical Center in Morristown, Tennessee. The Company recorded an impairment charge of approximately $9$27 million during the sixthree months ended June 30,December 31, 2018, to adjust the fair value of the supplies, inventory and long-lived assets of these hospitals, including property and equipment and capitalized software costs, based on their estimated fair value and future utilization. During 2019, the Company recorded an impairment charge of approximately $9 million to further adjust the fair value of the supplies, inventory and long-lived assets of these hospitals, including property and equipment and capitalized software costs, based on the Company’s updated evaluation of their estimated fair value and future utilization and consideration of costs to dispose of such assets.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

6.

INCOME TAXES

The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was approximately $1 million as of June 30, 2019. A total of approximately $1 million of interest and penalties is included in the amount of the liability for uncertain tax positions at June 30, 2019. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its condensed consolidated statements of loss as income tax expense.

It is possible the amount of unrecognized tax benefit could change in the next 12 months as a result of a lapse of the statute of limitations and settlements with taxing authorities; however, the Company does not anticipate the change will have a material impact on the Company’s condensed consolidated results of operations or condensed consolidated financial position.

The Company’s federal income tax returns for the 2009 and 2010 tax years have been settled with the Internal Revenue Service. The results of these examinations There were not material to the Company’s consolidated results of operations or consolidated financial position. The Company’s federal income tax returns for the 2014 and 2015 tax years remain under examination by the Internal Revenue Service. The Company believes the results of these examinations will not be material to its consolidated results of operations or consolidated financial position. The Company has extended the federal statute of limitations through December 31, 2020 for Community Health Systems, Inc. for the tax periods ended December 31, 2014 and 2015.

The Company’s effective tax rates were 2.0% and 29.5% for the three months ended June 30, 2019 and 2018, respectively, and (1.2)% and 31.5% for the six months ended June 30, 2019 and 2018, respectively. The difference in the Company’s effective tax rate for the three and six months ended June 30, 2019, when compared to the three and six months ended June 30, 2018, was primarily due to the increase in valuation allowance recognized on IRC Section 163(j) interest carryforwards and thewrite-off ofnon-deductible goodwill.

Cash paid for income taxes, net of refunds received, resulted in a net refund of $3 million and $9 million during the three months ended June 30, 2019 and 2018, respectively, and a net refund of $3 million and $9 million0 hospital closures during the six months ended June 30, 2019 and 2018, respectively.2020.

4.  GOODWILL AND OTHER INTANGIBLE ASSETS  

7.

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

The changes in the carrying amount of goodwill for the six months ended June 30, 20192020 are as follows (in millions):

 

Balance, as of December 31, 2018

Goodwill

$                    7,373 

Accumulated impairment losses

(2,814)

Balance, as of December 31, 2019

 

 

 

 

Goodwill

 

$

7,142

 

Accumulated impairment losses

 

 

(2,814

)

 

 

 

4,328

 

Goodwill allocated to hospitals held for sale

 

 

(103

)

Balance, as of June 30, 2020

 

 

 

 

Goodwill

 

 

7,039

 

Accumulated impairment losses

 

 

(2,814

)

 

 

$

4,225

 

 

4,559 

Goodwill acquired as part of acquisitions during current year

Goodwill allocated to hospitals held for sale

(68)

Balance, as of June 30, 2019

Goodwill

7,308 

Accumulated impairment losses

(2,814)

$4,494 

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 meetsegment meets the criteria to be classified as a reporting units.unit. At June 30, 2019,2020, after giving effect to 2020 divestiture activity, the Company had approximately $4.5$4.2 billion of goodwill recorded.

14


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Goodwill is evaluated for impairment annually 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. During 2017, the Company early adopted ASU2017-04, which allows a company to record a goodwill impairment when the reporting unit’s carrying value exceeds the fair value determined in step one. The Company performed its last annual goodwill impairment evaluation during the fourth quarter of 20182019 using the October 31, 2018 measurement date, which evaluation indicated no impairment. The next annual goodwill evaluation will be performed during the fourth quarter of 2019 with an October 31, 2019 measurement date, or sooner if the Company identifies certain indicators ofwhich indicated 0 impairment.

The Company estimates the fair value of the related reporting unitsunit using both a discounted cash flow model as well as a market 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.

While no impairment was indicated in the Company’s most recent annual goodwill evaluation as of the October 31, 20182019 measurement date, the reduction in the Company’s fair value and the resulting goodwill impairment charges recorded in 2016 and 2017 reduced the carrying value of the Company’s hospital operations reporting unit to an amount equal to its estimated fair value.value as of such prior year measurement dates. This increases the risk that future declines in fair value could result in goodwill impairment. The determination of fair value in the Company’s goodwill impairment analysis is based on an estimate of fair value for each reporting unit utilizing known and estimated inputs at the evaluation date. Some of those inputs include, but are not limited to, the most recent price of the Company’s common stock orand fair value of long-term debt, estimates of future revenue and expense growth, estimated market multiples, expected capital expenditures, income tax rates, and costs of invested capital. A detailed evaluation of potential impairment indicators was performed as of June 30, 2020, which specifically considered the volatility of the fair market value of the Company’s outstanding senior secured and unsecured notes and common stock during the six months ended June 30, 2020, as well as declines in patient volumes and net operating revenues resulting from the COVID-19 pandemic. On the basis of available evidence as of June 30, 2020, 0 indicators of impairment were identified.

Future estimates of fair value could be adversely affected if the actual outcome of one or more of thesethe assumptions described above changes materially in the future, including furthera decline in or volatility of the Company’s stock price orand the fair value of its long-term debt, lower than expected hospital volumes, higher market interest rates or increased operating costs. Such changes impacting the calculation of fair value, the risks of which are amplified by the COVID-19 pandemic, could result in a material impairment charge in the future.

The determination of fair value of the Company’s hospital operations reporting unit as part of its goodwill impairment measurement represents a Level 3 fair value measurement in the fair value hierarchy due to its use of internal projections and unobservable measurement inputs.

Intangible Assets

NoNaN intangible assets other than goodwill were acquired during the six months ended June 30, 2019.2020. The gross carrying amount of the Company’s other intangible assets subject to amortization was $1$1 million at both June 30, 20192020 and December 31, 2018,2019, and the net carrying amount was less than $1 million at both June 30, 20192020 and December 31, 2018.2019. The carrying amount of the Company’s other intangible assets not subject to amortization was $64$58 million and $67$63 million at June 30, 20192020 and December 31, 2018,2019, respectively. Other intangible assets are included in other assets, net on the Company’s condensed consolidated balance sheets. Substantially all of the Company’s intangible assets are contract-based intangible assets related to operating licenses, management contracts, tradenames, ornon-compete agreements entered into in connection with prior acquisitions.

The weighted-average remaining amortization period for the intangible assets subject to amortization is approximately two years. There are no expected residual values related to these intangible assets. Amortization expense on these intangible assets was less than $1 million for both of the three-month periods ended June 30, 2019 and 2018, and less than $1 million and $1 million for the six months ended June 30, 2019 and 2018, respectively. Amortization expense on intangible assets is estimated to be less than $1 million for the remainder of 2019 and in 2020 through 2022.

The gross carrying amount of capitalized software for internal use was approximately $1.2$1.1 billion at both June 30, 20192020 and December 31, 2018,2019, and the net carrying amount was approximately $355$270 million and $321 million at both June 30, 20192020 and December 31, 2018.2019, respectively. The estimated amortization period for capitalizedinternal-use software is generally three years, except for capitalized costs related to significant system conversions, which is generally eight to ten years. There is no0 expected residual value for capitalizedinternal-use software. At June 30, 2019,2020, there was approximately $53$42 million of capitalized costs forinternal-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 capitalizedinternal-use software was $31 million during both of the three-month periods ended June 30, 2020 and $342019, and $62 million and $61 million during the six months ended June 30, 2020 and 2019, respectively. Amortization expense on capitalized internal-use software is estimated to be $59 million for the remainder of 2020, $107 million in 2021, $58 million in 2022, $22 million in 2023, $11 million in 2024, $7 million in 2025 and $6 million thereafter.

15


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

5.  INCOME TAXES

The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was approximately $1 million as of June 30, 2020. A total of approximately $1 million of interest and penalties is included in the amount of the liability for uncertain tax positions at June 30, 2020. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its condensed consolidated statements of income (loss) as income tax expense.

It is possible the amount of unrecognized tax benefit could change in the next 12 months as a result of a lapse of the statute of limitations and settlements with taxing authorities; however, the Company does not anticipate the change will have a material impact on the Company’s condensed consolidated results of operations or financial position.

The Company’s federal income tax returns for the 2009 and 2010 tax years have been settled with the Internal Revenue Service. The results of these examinations were not material to the Company’s consolidated results of operations or financial position. The Company’s federal income tax returns for the 2014 and 2015 tax years remain under examination by the Internal Revenue Service. The Company believes the results of these examinations will not be material to its condensed consolidated results of operations or financial position. The Company has extended the federal statute of limitations through June 30, 2021 for Community Health Systems, Inc. for the tax periods ended December 31, 2014 and 2015. The Company’s federal income tax return for the 2018 tax year is under examination by the Internal Revenue Service.

The Company’s effective tax rates were (165.7)% and 2.0% for the three months ended June 30, 2020 and 2019, respectively, and 209.6% and (1.2)% for the six months ended June 30, 2020 and 2019, respectively. The difference in the Company’s effective tax rate for the three and six months ended June 30, 2020, when compared to the three and six months ended June 30, 2019, was primarily due to changes in tax benefits as a result of an increase to the deductible interest expense allowed for 2019 and 2020 under the CARES Act that was enacted during the three months ended March 31, 2020.

Cash paid for income taxes, net of refunds received, resulted in a net payment of less than $1 million during the three months ended June 30, 2020, and a net refund of approximately $3 million during the three months ended June 30, 2019, and 2018, respectively, and $61a net refund of $2 million and $70$3 million during the six months ended June 30, 20192020 and 2018, respectively. Amortization expense on capitalizedinternal-use software is estimated to be $60 million for the remainder of 2019, $118 million in 2020, $81 million in 2021, $46 million in 2022, $27 million in 2023, $15 million in 2024 and $8 million thereafter.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

8.

EARNINGS PER SHARE

The following table sets forth the components of the denominator for the computation of basic and diluted (loss) earnings per share attributable to Community Health Systems, Inc. common stockholders:

   Three Months Ended  Six Months Ended
   June 30,  June 30,
             2019                      2018                      2019                      2018          

Weighted-average number of shares outstanding — basic

   113,862,097    112,837,944    113,561,523    112,566,230 

Effect of dilutive securities:

        

Restricted stock awards

   -    -    -    - 

Employee stock options

   -    -    -    - 

Other equity-based awards

   -    -    -    - 
  

 

 

 

  

 

 

 

  

 

 

 

  

 

 

 

Weighted-average number of shares outstanding — diluted

       113,862,097        112,837,944        113,561,523        112,566,230 
  

 

 

 

  

 

 

 

  

 

 

 

  

 

 

 

The Company generated a loss attributable to Community Health Systems, Inc. common stockholders for the three andsix-month periods ended June 30, 2019 and 2018, so the effect of dilutive securities is not considered because their effect would be antidilutive. If the Company had generated income, the effect of restricted stock awards on the diluted shares calculation would have been an increase of 30,472 shares and 47,754 shares during the three months ended June 30, 2019 and 2018, respectively, and 44,867 shares and 60,558 shares during the six months ended June 30, 2019 and 2018, respectively.

6.  LONG-TERM DEBT

   Three Months Ended  Six Months Ended
   June 30,  June 30,
             2019                      2018                      2019                      2018          

Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:

        

Employee stock options and restricted stock awards

   4,020,947    1,792,512    3,908,725    1,856,431 
  

 

 

 

  

 

 

 

  

 

 

 

  

 

 

 

9.

STOCKHOLDERS’ DEFICIT

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 June 30, 2019, 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.

The Company is a holding company which operates through its subsidiaries. The Company’s Credit Facility and the indentures governing each series of its outstanding notes contain various covenants under which the assets of the subsidiaries of the Company are subject to certain restrictions relating to, among other matters, dividends and distributions, as referenced in the paragraph below.

With the exception of a special cash dividend of $0.25 per share paid by the Company in December 2012, historically, the Company has not paid any cash dividends. Subject to certain exceptions, the Company’s Credit Facility limits the ability of the Company’s subsidiaries to pay dividends and make distributions to the Company, and limits the Company’s ability to pay dividends and/or repurchase stock, to an amount not to exceed $100 million in the aggregate. The indentures governing each series of our outstanding notes also restrict the Company’s subsidiaries from, among other matters, paying dividends and making distributions to the Company, which thereby limits the Company’s ability to pay dividends and/or repurchase stock. As of June 30, 2019, under the most restrictive test in these agreements (and subject to certain exceptions), the Company has approximately $100 million available with which to pay permitted dividends and/or repurchase shares of stock or make other restricted payments.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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 as of June 30, 2019, and during each of the three-month periods following December 31, 2018 (in millions):

          Community Health Systems, Inc. Stockholders       
  Redeemable
  Noncontrolling  
Interest
         Common 
Stock
   Additional 
Paid-In
Capital
  

 

Accumulated

Other
 Comprehensive 
Loss

   Accumulated 
Deficit
   Noncontrolling 
Interest
  Total
  Stockholders’  
Deficit
 

Balance, December 31, 2018

 $504     $ $2,017  $(10)  $(3,543)  $72  $(1,463) 

Comprehensive income (loss)

       -   -   -   (118)     (110) 

Contributions from noncontrolling interests

       -   -   -   -   -   - 

Distributions to noncontrolling interests

  (19)      -   -   -   -   (8)   (8) 

Purchase of subsidiary shares from noncontrolling interests

  (1)      -   -   -   -   -   - 

Other reclassifications of noncontrolling interests

  (1)      -   -   -   -     

Adjustment to redemption value of redeemable noncontrolling interests

  12      -   (12)   -   -   -   (12) 

Cancellation of restricted stock for tax withholdings on vested shares

  -      -   (1)   -   -   -   (1) 

Share-based compensation

  -      -     -   -   -   
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Balance, March 31, 2019

  505        2,007   (10)   (3,661)   73   (1,590) 

Comprehensive income (loss)

  14      -   -     (167)     (157) 

Contributions from noncontrolling interests

       -   -   -   -   -   - 

Distributions to noncontrolling interests

  (22)      -   -   -   -   (8)   (8) 

Purchase of subsidiary shares from noncontrolling interests

  -      -   (1)   -   -   -   (1) 

Other reclassifications of noncontrolling interests

  (1)      -   (1)   -   -     - 

Adjustment to redemption value of redeemable noncontrolling interests

       -   (6)   -   -   -   (6) 

Share-based compensation

  -      -     -   -   -   
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Balance, June 30, 2019

 $503     $ $2,002  $(8)  $(3,828)  $74  $(1,759) 
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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 as of June 30, 2018, and during each of the three-month periods following December 31, 2017 (in millions):

          Community Health Systems, Inc. Stockholders       
  Redeemable
  Noncontrolling  
Interest
         Common 
Stock
   Additional 
Paid-In
Capital
  

 

Accumulated

Other
 Comprehensive 
Loss

   Accumulated 
Deficit
   Noncontrolling 
Interest
  Total
  Stockholders’  
Deficit
 

Balance, December 31, 2017

 $527     $ $2,014  $(21)  $(2,761)  $75  $(692) 

Comprehensive income (loss)

  13      -   -   17   (25)     (2) 

Adoption of new accounting standards

  -      -   -   (12)   12   -   - 

Distributions to noncontrolling interests

  (17)      -   -   -   -   (6)   (6) 

Purchase of subsidiary shares from noncontrolling interests

  (1)      -   (2)   -   -   -   (2) 

Other reclassifications of noncontrolling interests

       -   -   -   -   (1)   (1) 

Cancellation of restricted stock for tax withholdings on vested shares

  -      -   (2)   -   -   -   (2) 

Share-based compensation

  -      -     -   -   -   
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Balance, March 31, 2018

  523        2,014   (16)   (2,774)   74   (701) 

Comprehensive income (loss)

       -   -     (110)   10   (93) 

Contributions from noncontrolling interests

  -      -   -   -   -     

Distributions to noncontrolling interests

  (20)      -   -   -   -   (9)   (9) 

Purchase of subsidiary shares from noncontrolling interests

  (1)      -   (1)   -   -   (1)   (2) 

Other reclassifications of noncontrolling interests

  (1)      -   -   -   -     

Adjustment to redemption value of redeemable noncontrolling interests

       -   (5)   -   -   -   (5) 

Cancellation of restricted stock for tax withholdings on vested shares

  -      -     -   -   -   

Share-based compensation

  -      -     -   -   -   
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Balance, June 30, 2018

 $514     $ $2,013  $(9)  $(2,884)  $76  $(803) 
 

 

 

     

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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’ deficit (in millions):

   Three Months Ended   Six Months Ended 
   June 30,   June 30, 
             2019                       2018                       2019                       2018           

Net loss attributable to Community Health Systems, Inc. stockholders

  $(167)   $(110)   $(285)   $(135) 

Transfers to the noncontrolling interests:

        

Net decrease in Community Health Systems, Inc.paid-in-capital for purchase of subsidiary partnership interests

   (1)    (1)    (1)    (3) 
  

 

 

   

 

 

   

 

 

   

 

 

 

Net transfers to the noncontrolling interests

   (1)    (1)    (1)    (3) 
  

 

 

   

 

 

   

 

 

   

 

 

 

Change to Community Health Systems, Inc. stockholders’ deficit from net loss attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests

  $(168)   $(111)   $(286)   $(138) 
  

 

 

   

 

 

   

 

 

   

 

 

 

10.

LONG-TERM DEBT

Long-term debt, net of unamortized debt issuance costs and discounts or premiums, consists of the following (in millions):

 

             June 30,                 December 31,     
   2019   2018 

Credit Facility:

    

Term H Loan

   $    $1,622  

Revolving Credit Facility

   ��    

8% Senior Notes due 2019

   155     155  

718% Senior Notes due 2020

   121     121  

518% Senior Secured Notes due 2021

   1,000     1,000  

678% Senior Notes due 2022

   2,632     2,632  

614% Senior Secured Notes due 2023

   3,100     3,100  

858% Senior Secured Notes due 2024

   1,033     1,033  

8% Senior Secured Notes due 2026

   1,601      

Junior-Priority Secured Notes due 2023

   1,770     1,770  

Junior-Priority Secured Notes due 2024

   1,355     1,355  

ABL Facility

   723     698  

Finance lease and financing obligations

   225     231  

Other

   45     43  

Less: Unamortized deferred debt issuance costs and note premium

   (161)    (164) 
  

 

 

   

 

 

 

Total debt

   13,599     13,596  

Less: Current maturities

   (206)    (204) 
  

 

 

   

 

 

 

Total long-term debt

   $13,393     $13,392  
  

 

 

   

 

 

 

 

 

June 30,

 

 

December 31,

 

 

 

2020

 

 

2019

 

5⅛% Senior Secured Notes due 2021

 

$

 

 

$

1,000

 

6⅞% Senior Notes due 2022

 

 

231

 

 

 

231

 

6¼% Senior Secured Notes due 2023

 

 

2,675

 

 

 

3,100

 

8⅝% Senior Secured Notes due 2024

 

 

1,033

 

 

 

1,033

 

6⅝% Senior Secured Notes due 2025

 

 

1,462

 

 

 

 

8% Senior Secured Notes due 2026

 

 

2,101

 

 

 

2,101

 

8% Senior Secured Notes due 2027

 

 

700

 

 

 

700

 

6⅞% Senior Notes due 2028

 

 

1,700

 

 

 

1,700

 

9⅞% Junior-Priority Secured Notes due 2023

 

 

1,770

 

 

 

1,770

 

8⅛% Junior-Priority Secured Notes due 2024

 

 

1,355

 

 

 

1,355

 

ABL Facility

 

 

 

 

 

273

 

Finance lease and financing obligations

 

 

242

 

 

 

272

 

Other

 

 

27

 

 

 

17

 

Less:  Unamortized deferred debt issuance costs and note premium

 

 

(160

)

 

 

(147

)

Total debt

 

 

13,136

 

 

 

13,405

 

Less: Current maturities

 

 

(30

)

 

 

(20

)

Total long-term debt

 

$

13,106

 

 

$

13,385

 

On February 6, 2020, CHS/Community Health Systems, Inc. (“CHS”) completed a private offering of $1.462 billion aggregate principal amount of 6⅝% Senior Secured Notes due February 15, 2025 (the “6⅝% Senior Secured Notes due 2025”). CHS used the net proceeds of the offering of the 6⅝% Senior Secured Notes due 2025 to (i) purchase any and all of its 5⅛% Senior Secured Notes

16


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Credit Facility

The Company’s wholly-owned subsidiary, CHS/Community Health Systems, Inc. (“CHS”), has senior secured financing under a credit facility with a syndicate of financial institutions led by Credit Suisse, as administrative agent and collateral agent (the “Credit Facility”), which at December 31, 2018 included (i) a revolving credit facility with commitments through January 27, 2021 of $425 million (the “Revolving Facility”), and (ii) a Term H facility due 2021 (the “Term H Facility). The Revolving Facility includes a subfacility for letters of credit.

The loans under the Credit Facility bore 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 NYFRB 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) LIBOR. In addition, the margin in respect of the Revolving Facility is subject to adjustment determined by reference to a leverage-based pricing grid. Based on the Company’s current leverage, loans in respect of the Revolving Facility currently accrue interest at a rate per annum equal to LIBOR plus 2.75%,validly tendered and not validly withdrawn in the case of LIBOR borrowings, and Alternate Base Rate plus 1.75%, in the case of Alternate Base Rate borrowings. Prior to the refinancing discussed below, the Term H Loan accrued interest at a rate per annum equal to LIBOR plus 3.25%, in the case of LIBOR borrowings, and Alternate Base Rate plus 2.25%, in the case of Alternate Base Rate borrowings. The Term H Loan was subject to a 1.00% LIBOR floor and a 2.00% Alternate Base Rate floor.

The term loan facility was required to 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 (as further described below), (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) 75%, subject to reduction to a lower percentage basedtender offer announced on the Company’s first lien net leverage ratio (as defined in the Credit Facility generally as the ratio of first lien net debt on the date of determination to the Company’s consolidated EBITDA, as defined, for the four quarters most recently ended prior to such date), of excess cash flow (as defined) for any year, subject to certain exceptions. Voluntary prepayments and commitment reductions were permitted in whole or in part, without any premium or penalty, subject to minimum prepayment or reduction requirements. There were no scheduled principal amortization payments on the Term H Facility after December 31, 2018.

The borrower 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 substantiallyJanuary 23, 2020, (ii) redeem 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 ofnon-significant subsidiaries, syndication subsidiaries, securitization subsidiaries and joint venture subsidiaries, and subject to the ABL Facility. Such assets constitute substantially the same assets, subject to certain exceptions, that secure (i) on a first lien basis CHS’ obligations under the 5185⅛% Senior Secured Notes the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes (in each case, as defined below) and (ii) on a junior-priority basis the 2023 Junior-Priority Notes and the 2024 Junior-Priority Notes (in each case, as defined below).

CHS has agreed to pay letter of credit fees equal to the applicable percentage then in effect with respect to LIBOR borrowings under the Revolving 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 adjustment based upon the Company’s leverage ratio) on the unused portion of the Revolving Facility.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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 first lien net debt to consolidated EBITDA leverage ratio) and various affirmative covenants. Under the Credit Facility, the first lien net debt to consolidated EBITDA ratio is calculated as the ratio of total first lien debt, less unrestricted cash and cash equivalents, to consolidated EBITDA, as defined in the Credit Facility. The calculation of consolidated EBITDA as defined in the Credit Facility is a trailing12-month calculationdue 2021 that begins with net income attributable to the Company, with certain pro forma adjustments to consider the impact of material acquisitions or divestitures, and adjustments for interest, taxes, depreciation and amortization, net income attributable to noncontrolling interests, stock compensation expense, restructuring costs, and the financial impact of othernon-cash ornon-recurring items recorded during any such12-month period. For the12-month period ended June 30, 2019, the first lien net debt to consolidated EBITDA ratio financial covenant under the Credit Facility limited the ratio of first lien net debt to consolidated EBITDA, as defined, to less than or equal to 5.25 to 1.0. The Company was in compliance with all such covenants at June 30, 2019, with a first lien net debt to consolidated EBITDA ratio of approximately 4.96 to 1.0.

Events of default under the Credit Facility include, but arewere 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 an available cure, (4) bankruptcy and insolvency 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 (as defined), (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 June 30, 2019, the availability for additional borrowings under the Credit Facility, subject to certain limitations as set forth in the Credit Facility, was approximately $385 millionpurchased pursuant to the Revolving Facility, of which no borrowings were outstanding. As of June 30, 2019, the Company had letters of credit issued, primarilysuch tender offer, (iii) purchase in support of potential insurance-related claims and certain bonds, of approximately $148 million. CHS has the ability to amend the Credit Facility to provide for one or more tranches of term loans or increases in the Revolving Facility in an aggregate principal amount of up to $500 million. As of June 30, 2019, the weighted-average interest rate under the Credit Facility, excluding swaps, was 6.4%.

On February 15, 2019, the Company and CHS entered into Amendment No. 1 (the “Agreement”), among the Company, CHS, the subsidiary guarantors party thereto, the lenders party thereto and Credit Suisse AG, Cayman Islands Branch, as administrative agent and collateral agent, to the Credit Facility. The Credit Facility was amended by the Agreement, with requisite covenant lender approval, to amend the first lien net debt to EBITDA ratio financial covenant and to reduce the extended revolving credit commitments to $385 million. The amended financial covenant provides for a maximum first lien net debt to EBITDA ratio of 5.00 to 1.0 from July 1, 2018 through December 31, 2018, 5.25 to 1.0 from January 1, 2019 through December 31, 2019, 5.00 to 1.00 from January 1, 2020 through June 30, 2020, 4.50 to 1.00 from July 1, 2020 through September 30, 2020, and 4.25 to 1.0 thereafter. In addition, CHS agreed pursuant to the Agreement to further restrict its ability to make restricted payments. The revolving credit commitments will terminate on January 27, 2021. The amended Credit Facility includes a91-day springing maturity date applicable if more than $250 million in the aggregate principal amount of our 8% Senior Notes, 71/8% Senior Notes, Term H Facility or refinancings thereof are scheduled to mature or similarly become due within 91 days of such date.

On March 6, 2019, CHS completed a private offering of $1.601 billion aggregate principal amount of 8% Senior Secured Notes due March 15, 2026 (the “8% Senior Secured Notes”). The terms of the 8% Senior Secured Notes are discussed below. Using the proceeds from the offering, the Company repaid the outstanding balance owed under the Term H Loan and paid fees and expenses related to the offering.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

8% Senior Notes due 2019

On November 22, 2011, CHS completed a private offering of $1.0 billion aggregate principal amount of 8% Senior Notes due November 15, 2019 (the “8% Senior Notes”). 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 878% Senior Notes due 2015 and related fees and expenses. On March 21, 2012, CHS completed an offering of an additional $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 ofprivately negotiated transactions approximately $850$426 million aggregate principal amount of CHS’ then outstanding 878% Senior Notes due 2015, 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. Interest on the 8% Senior Notes accrues from the date of original issuance. Interest is calculated on the basis of a360-day year comprised of twelve30-day months.

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 par, 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).

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 Securities Act of 1933, as amended (the “1933 Act”)). References to the 8% Senior Notes shall also be deemed to include the 8% Exchange Notes unless the context provides otherwise.

On June 22, 2018, CHS issued approximately $1.770 billion aggregate principal amount of new Junior-Priority Secured Notes due June 30, 2023 (the “2023 Junior-Priority Notes”) in exchange for the same amount of 8% Senior Notes. The terms of the 2023 Junior-Priority Notes are described below. Following this exchange, CHS had $155 million aggregate principal amount of 8% Senior Notes outstanding.

718% Senior Notes due 2020

On July 18, 2012, CHS completed a public offering of 718% Senior Notes due July 15, 2020 (the “718% Senior Notes”). The net proceeds from this issuance were used to finance the purchase or redemption of $934 million aggregate principal amount of CHS’ then outstanding 878% Senior Notes due 2015, to pay for consents delivered in connection with a related tender offer, to pay related fees and expenses, and for general corporate purposes. The 718% Senior Notes bear interest at 7.125% per annum, payable semiannually in arrears on July 15 and January 15. Interest on the 718% Senior Notes accrues from the date of original issuance. Interest is calculated on the basis of a360-day year comprised of twelve30-day months.

CHS is entitled, at its option, to redeem all or a portion of the 718% Senior Notes upon not less than 30 nor more than 60 days’ notice at par, 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).

On June 22, 2018, CHS issued approximately $1.079 billion aggregate principal amount of new Junior-Priority Secured Notes due June 30, 2024 (the “2024 Junior-Priority Notes”) in exchange for the same amount of 718% Senior Notes. The terms of the 2024 Junior-Priority Notes are described below. Following this exchange, CHS had $121 million aggregate principal amount of 718% Senior Notes outstanding.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

518% Senior Secured Notes due 2021

On January 27, 2014, CHS completed a private offering of $1.0 billion aggregate principal amount of 518% Senior Secured Notes due August 1, 2021 (the “518% Senior Secured Notes”). The net proceeds from this issuance were used to finance the Company’s acquisition by merger of Health Management Associates (“HMA”). The 518% Senior Secured Notes bear interest at 5.125% per annum, payable semiannually in arrears on February 1 and August 1. Interest on the 518% Senior Secured Notes accrues from the date of original issuance. Interest is calculated on the basis of a360-day year comprised of twelve30-day months.

The 518% Senior Secured Notes and the related guarantees are secured by (i) first-priority liens on the collateral (the“Non-ABL Priority Collateral”) that also secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes and (ii) second-priority liens on the collateral (the“ABL-Priority Collateral”) that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis the Credit Facility and the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 518% Senior Secured Notes.    

CHS is entitled, at its option, to redeem all or a portion of the 518% 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        

February 1, 2019 to January 31, 2020

101.281 %  

February 1, 2020 to January 31, 2021

100.000 %  

Pursuant to a registration rights agreement entered into at the time of the issuance of the 518% Senior Secured Notes, as a result of an exchange offer made by CHS, all of the 518% Senior Secured Notes issued in January 2014 were exchanged in October 2014 for new notes (the “2021 Exchange Notes”) having terms substantially identical in all material respects to the 518% Senior Secured Notes (except that the exchange notes were issued under a registration statement pursuant to the 1933 Act). References to the 518% Senior Secured Notes shall be deemed to be the 2021 Exchange Notes unless the context provides otherwise.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

678% Senior Notes due 2022

On January 27, 2014, CHS completed a private offering of $3.0 billion aggregate principal amount of 678% Senior Notes due February 1, 2022 (the “678% Senior Notes”). The net proceeds from this issuance were used to finance the HMA merger. The 678% Senior Notes bear interest at 6.875% per annum, payable semiannually in arrears on February 1 and August 1. Interest on the 678% Senior Notes accrues from the date of original issuance. Interest is calculated on the basis of a360-day year comprised of twelve30-day months.

CHS is entitled, at its option, to redeem all or a portion of the 678% 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        

February 1, 2019 to January 31, 2020

101.719 %  

February 1, 2020 to January 31, 2022

100.000 %  

Pursuant to a registration rights agreement entered into at the time of the issuance of the 678% Senior Notes, as a result of an exchange offer made by CHS, all of the 678% Senior Notes issued in January 2014 were exchanged in October 2014 for new notes (the “678% Exchange Notes”) having terms substantially identical in all material respects to the 678% Senior Notes (except that the exchange notes were issued under a registration statement pursuant to the 1933 Act). References to the 678% Senior Notes shall be deemed to be the 678% Exchange Notes unless the context provides otherwise.

On June 22, 2018, CHS issued approximately $276 million aggregate principal amount of the 2024 Junior-Priority Notes in exchange for approximately $368 million of 678% Senior Notes. Following this exchange, CHS had $2.632 billion aggregate principal amount of 678% Senior Notes outstanding.

614% Senior Secured Notes due 2023 and (iv) pay related fees and expenses.

On March 16, 2017, CHS completed a public offering of $2.2 billion aggregate principal amount of 614The 6⅝% Senior Secured Notes due March 31, 2023 (the “614% Senior Secured Notes”). The net proceeds from this issuance were used to finance the purchase or redemption of $700 million aggregate principal amount of CHS’ then outstanding 2018 Senior Secured Notes and related fees and expenses, and the repayment of $1.445 billion of the Term F Facility. On May 12, 2017, CHS completed atack-on offering of $900 million aggregate principal amount of 614% Senior Secured Notes, increasing the total aggregate principal amount of 614% Senior Secured Notes to $3.1 billion. A portion of the net proceeds from this issuance were used to finance the repayment of approximately $713 million aggregate principal amount of CHS’ then outstanding Term A Facility and related fees and expenses. Thetack-on notes have identical terms, other than issue date and issue price as the 614% Senior Secured Notes issued on March 16, 2017. The 614% Senior Secured Notes bear interest at 6.250% per annum, payable semiannually in arrears on March 31 and September 30. Interest on the 614% Senior Secured Notes accrues from the date of original issuance. Interest is calculated on the basis of a360-day year comprised of twelve30-day months.

The 614% Senior Secured Notes and the related guarantees are secured by (i) first-priority liens on theNon-ABL Priority Collateral that also secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 518% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes and (ii) second-priority liens on theABL-Priority Collateral that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis the Credit Facility and the 518% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 614% Senior Secured Notes.

CHS is entitled, at its option, to redeem all or a portion of the 614% Senior Secured Notes at any time prior to March 31, 2020, upon not less than 30 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 614% Senior Secured Notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 614% Senior Secured Notes. In addition, CHS may redeem up to 40% of the aggregate principal amount of the 614% Senior Secured Notes at any time prior to March 31, 2020 using the net proceeds from certain equity offerings at the redemption price of 106.250% of the principal amount of the 614% Senior Secured Notes redeemed, plus accrued and unpaid interest, if any.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

CHS may redeem some or all of the 614% Senior Secured Notes at any time on or after March 31, 2020 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        

March 31, 2020 to March 30, 2021

103.125 %  

March 31, 2021 to March 30, 2022

101.563 %  

March 31, 2022 to March 30, 2023

100.000 %  

Junior-Priority Secured Notes due 2023

On June 22, 2018, CHS completed a private offering of $1.770 billion aggregate principal amount of the 2023 Junior-Priority Notes in exchange for the same amount of 8% Senior Notes. The 2023 Junior-Priority Notes bear interest at (i) 11% per annum from June 22, 2018 to, but excluding, June 22, 2019 and (ii) 978% per annum from June 22, 2019 until maturity, payable semiannually in arrears on June 30 and December 31.

The 2023 Junior-Priority Notes and the related guarantees are secured by (i) second-priority liens on theNon-ABL Priority Collateral that secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 518% Senior Secured Notes, the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes and (ii) third-priority liens on theABL-Priority Collateral that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis the Credit Facility, the 518% Senior Secured Notes, the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 2023 Junior-Priority Notes.

Prior to June 30, 2020, CHS may redeem some or all of the 2023 Junior-Priority 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 indenture governing the 2023 Junior-Priority Notes. In addition, at any time prior to June 30, 2020, CHS may redeem up to 40% of the aggregate principal amount of the 2023 Junior-Priority Notes with the proceeds of certain equity offerings at 109.875%, plus accrued and unpaid interest, if any, to, but excluding, the applicable redemption date.

After June 30, 2020, CHS is entitled, at its option, to redeem all or a portion of the 2023 Junior-Priority Notes upon not less than 15 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        

June 30, 2020 to June 29, 2021

107.406 %  

June 30, 2021 to June 29, 2022

103.703 %  

June 30, 2022 to June 29, 2023

100.000 %  

Junior-Priority Secured Notes due 2024

On June 22, 2018, CHS completed a private offering of $1.355 billion aggregate principal amount of the 2024 Junior-Priority Notes in exchange for approximately $1.079 billion of 718% Senior Notes and approximately $368 million of 678% Senior Notes. The 2024 Junior-Priority Notes2025 bear interest at a rate of 818%6.625% per annum, payable semiannually in arrears on June 30 and December 31.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

The 2024 Junior-Priority Notes and the related guarantees are secured by (i) second-priority liens on theNon-ABL Priority Collateral that secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 518% Senior Secured Notes, the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes and (ii) third-priority liens on theABL-Priority Collateral that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis the Credit Facility, the 518% Senior Secured Notes, the 614% Senior Secured Notes, the 858% Senior Secured Notes and the 8% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 2024 Junior-Priority Notes.

Prior to June 30, 2021, CHS may redeem some or all of the 2024 Junior-Priority 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 indenture governing the 2024 Junior-Priority Notes. In addition, at any time prior to June 30, 2021, CHS may redeem up to 40% of the aggregate principal amount of the 2024 Junior-Priority Notes with the proceeds of certain equity offerings at 108.125%, plus accrued and unpaid interest, if any, to, but excluding, the applicable redemption date.

After June 30, 2021, CHS is entitled, at its option, to redeem all or a portion of the 2024 Junior-Priority Notes upon not less than 15 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        

June 30, 2021 to June 29, 2022

104.063 %  

June 30, 2022 to June 29, 2023

102.031 %  

June 30, 2023 to June 29, 2024

100.000 %  

The indentures governing each of the 2023 Junior-Priority Notes and 2024 Junior-Priority Notes also prohibit CHS from purchasing, repurchasing, redeeming, defeasing or otherwise acquiring or retiring any outstanding 8% Senior Notes and 718% Senior Notes with: (a) cash or cash equivalents on hand as of the consummation of the exchange offers; (b) cash generated from operations; (c) proceeds from assets sales; or (d) proceeds from the issuance of, or in exchange for, secured debt, in each case, prior to the date that is 60 days prior to the relevant maturity dates of such 8% Senior Notes and 718% Senior Notes, as applicable.

858% Senior Secured Notes due 2024

On July 6, 2018, CHS completed a private offering of $1.033 billion aggregate principal amount of 858% Senior Secured Notes due January 15, 2024 (the “858% Senior Secured Notes”). The terms of the 858% Senior Secured Notes are governed by an indenture, dated as of July 6, 2018, among CHS, the Company, the subsidiary guarantors party thereto, Regions Bank, as trustee and Credit Suisse AG, as collateral agent. The 858% Senior Secured Notes bear interest at a rate of 858% per year payable semi-annually in arrears on JanuaryFebruary 15 and JulyAugust 15 of each year, commencing on JanuaryAugust 15, 2019.2020. The notes6⅝% Senior Secured Notes are scheduled to mature on February 15, 2025. The 6⅝% Senior Secured Notes due 2025 are unconditionally guaranteed on a senior-priority secured basis by the Company and each of the CHS current and future domestic subsidiaries that provide guarantees under CHS’ senior secured credit facilities, CHS’ ABLthe revolving asset-based loan facility (the “ABL Facility”), any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 8586⅝% Senior Secured Notes due 2025 and the related guarantees are secured by shared (i) first-priority liens on theNon-ABL Priority Collateral that also secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 518% Senior Secured Notes, the 614% Senior Secured Notes and the 8% Senior Secured Notes and (ii) second-priority liens on theABL-Priority ABL Priority Collateral that secures on a first-priority basis the ABL Facility, (and also secures on a second-priority basis the Credit Facility and the 518% Senior Secured Notes, the 614% Senior Secured Notes and the 8% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 8586⅝% Senior Secured Notes.

Notes due 2025.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

PriorAt any time prior to JanuaryFebruary 15, 2021,2022, CHS may redeem some or all of the 8586⅝% Senior Secured Notes due 2025 at a redemption price equal to 100% of thetheir principal amount of the notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 858% Senior Secured Notes. In addition, at any time prior to January 15, 2021, CHS may redeem up to 40% of the aggregate principal amount of the 858% Senior Secured Notes with the proceeds of certain equity offerings at 108.625%, plus accrued and unpaid interest, if any, to, but excluding the applicable redemption date.

date plus a make-whole premium as defined in the indenture agreement dated February 6, 2020. After JanuaryFebruary 15, 2021,2022, CHS is entitled, at its option, to redeem all or a portion of the 858% Senior Secured Notes upon not less than 15 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        

January 15, 2021 to January 14, 2022

104.313 %  

January 15, 2022 to January 14, 2023

102.156 %  

January 15, 2023 to January 14, 2024

100.000 %  

8% Senior Secured Notes due 2026

On March 6, 2019, CHS completed a private offering of $1.601 billion aggregate principal amount of the 8% Senior Secured Notes. The terms of the 8% Senior Secured Notes are governed by an indenture, dated as of March 6, 2019, among CHS, the Company, the subsidiary guarantors party thereto, Regions Bank, as trustee and Credit Suisse AG, as collateral agent. The 8% Senior Secured Notes bear interest at a rate of 8% per year payable semi-annually in arrears on March 15 and September 15 of each year, commencing on September 15, 2019. The notes are unconditionally guaranteed on a senior-priority secured basis by the Company and each of the CHS current and future domestic subsidiaries that provide guarantees under CHS’ senior secured credit facilities, CHS’ ABL facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 8% Senior Secured Notes and the related guarantees are secured by (i) first-priority liens on theNon-ABL Priority Collateral that also secures on a first-priority basis the Credit Facility (subject to certain exceptions), the 518% Senior Secured Notes, the 614% Senior Secured Notes, and the 858% Senior Secured Notes and (ii) second-priority liens on theABL-Priority Collateral that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis the Credit Facility and the 518% Senior Secured Notes, the 614% Senior Secured Notes, and the 858% Senior Secured Notes), in each case subject to permitted liens described in the indenture governing the 8% Senior Secured Notes.

Prior to March 15, 2022, CHS may redeem some or all of the 8%6⅝% Senior Secured Notes at a redemption price equal to 100%the percentage of the principal amount of the notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 8% Senior Secured Notes. In addition, at any time prior to March 15, 2022, CHS may redeem up to 40% of the aggregate principal amount of the 8% Senior Secured Notes with the proceeds of certain equity offerings at 108.000%,below plus accrued and unpaid interest, if any, to, but excluding the applicable redemption date.

After March 15, 2022, CHS is entitled, at its option, to redeem all or a portion of the 8% Senior Secured Notes upon not less than 15 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 periodstwelve-month period beginning on February 15 of the years set forth below:

 

Period

Redemption

Price

 

MarchFebruary 15, 2022 to MarchFebruary 14, 2023

104.000

103.313

%

MarchFebruary 15, 2023 to MarchFebruary 14, 2024

102.000

101.656

%

MarchFebruary 15, 2024 to MarchFebruary 14, 20262025

100.000

%

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

 

ABL FacilityThere was 0 loss on early extinguishment of debt for the three months ended June 30, 2020 and 2019. Financing and repayment transactions resulted in a pre-tax loss from early extinguishment of debt of $4 million and $31 million for the six months ended June 30, 2020 and 2019, respectively, and an after-tax loss of $3 million and $23 million for the six months ended June 30, 2020 and 2019, respectively.

On April 3, 2018, the Company and CHS entered into an asset-based loan (ABL) credit agreement (the “ABL Credit Agreement”) (as further described below), with JPMorgan Chase Bank, N.A., as administrative agent, and the lenders and other agents party thereto. Pursuant to the ABL Credit Agreement, the lenders have extended to CHS a revolving asset-based loan facility (the “ABL Facility”) in theThe maximum aggregate principal amount of $1.0 billion, subject to borrowing base capacity. The ABL facility includes borrowing capacity available for letters of credit of $50 million. CHS and all domestic subsidiaries of CHS that guarantee CHS’ other outstanding senior and senior secured indebtedness guarantee the obligations of CHS under the ABL Facility. In conjunction with the closing of the ABL Facility, the wholly-owned special-purpose entity that owned the Receivables pledged under the previous Receivables Facility became a subsidiary guarantor under the Credit Facility and CHS’ outstanding notes. Subject to certain exceptions, all obligations under the ABL Facility and the related guarantees are secured by a perfected first-priority security interest in substantially all of the Receivables, deposit, collection and other accounts and contract rights, books, records and other instruments related to the foregoing of the Company, CHS and the guarantors as well as a perfected junior-priority security interest in substantially all of the other assets of the Company, CHS and the guarantors, subject to customary exceptions and intercreditor arrangements. The revolving credit commitments under the Credit Facility were reduced to $425 million upon the effectiveness of the ABL Facility. In connection with entering into the ABL Credit Agreement and the ABL Facility, the Company repaid in full and terminated its Receivables Facility. The outstanding borrowings pursuant to the ABL Facility at June 30, 2019 totaled $723 million on the condensed consolidated balance sheet.

Borrowings under the ABL Facility bear interest at a rate per annum equal to an applicable percentage, plus, at the Borrower’s option, either (a) an Alternative base rate or (b) a LIBOR rate. From and after December 31, 2018, the applicable percentage under the ABL Facility will be determined based on excess availability as a percentage of the maximum commitment amount under the ABL facility at a rate per annum of 1.25%, 1.50% and 1.75% for loans based on the Alternative base rate and 2.25%, 2.50% and 2.75% for loans based on the LIBOR rate. From and after September 30, 2018, the applicable commitment fee rate under the ABL Facility is determined based on average utilization as a percentage of$1.0 billion. At June 30, 2020, the maximum commitment amountavailable borrowing base under the ABL Facility at a rate per annumwas $614 million, of either 0.50% or 0.625% timeswhich the unused portionCompany had 0 outstanding borrowings and letters of the ABL facility.

Principal amounts outstanding under the ABL Facility will be duecredit issued of $180 million. The issued letters of credit were primarily in support of potential insurance-related claims and payable in full on April 3, 2023. The ABL Facility includes a91-day springing maturity applicable if more than $250 million in the aggregate principal amount of the Borrower’s 8% Senior Notes due 2019, Term G loans due 2019, 7.125% Senior Notes due 2020, Term H loans due 2021, 5.125% Senior Secured Notes due 2021, 6.875% Senior Notes due 2022 or 6.25% Senior Secured Notes due 2023 or refinancings thereof are scheduled to mature or similarly become due on a date prior to April 3, 2023.certain bonds.

The ABL Facility contains customary representations and warranties, subject to limitations and exceptions, and customary covenants restricting ourthe Company’s 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) engage in mergers, acquisitions and asset sales, (7) conduct transactions with affiliates, (8) alter the nature of the Company’s, CHS’ or the guarantors’ businesses, (9) grant certain guarantees with respect to physician practices, (10) engage in sale and leaseback transactions or (11) change ourthe Company’s fiscal year. The Company is also required to comply with a consolidated fixed coverage ratio, upon certain triggering events described below, and various affirmative covenants. The consolidated fixed coverage ratio is calculated as the ratio of (x) consolidated EBITDA (as defined in the ABL Facility) less capital expenditures to (y) the sum of consolidated interest expense (as defined in the ABL Facility), scheduled principal payments, income taxes and restricted payments made in cash or in permitted investments. For purposes of calculating the consolidated fixed charge coverage ratio, the calculation of consolidated EBITDA as defined in the ABL Facility is a trailing12-month calculation that begins with the Company’s consolidated net income, attributable to Holdings, with certain adjustments for interest, taxes, depreciation and amortization, net income attributable to noncontrolling interests, stock compensation expense, restructuring costs, and the financial impact of othernon-cash ornon-recurring items recorded during any such12-month period. The consolidated fixed charge coverage ratio is a required covenant only in periods where the total borrowings outstanding under the ABL Facility reduce the amount available in the facility to less than the greater of (i) $95 million andor (ii) 10% of the calculated borrowing base. As a result, in the event the Company has less than $95 million available under the ABL Facility, the Company would need to comply with the consolidated fixed charge coverage ratio. At June 30, 2019,2020, the Company is not subject to the consolidated fixed charge coverage ratio as such triggering event had not occurred during the last twelve months ended June 30, 2019.

2020.

17


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Events of default under the ABL Facility include, but are not limited to, (1) CHS’ failure to pay principal, interest, fees or other amounts under the ABL 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 an available cure and applicable grace periods, (4) bankruptcy and insolvency 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 (as defined), (8) certain ERISA-related defaults and (9) the invalidity or impairment of specified security interests, guarantees or subordination provisions in favor of the ABL Agent or lenders under the ABL Facility.

Receivables Facility

Prior to the effectiveness of the ABL Facility described above, CHS, through certain of its subsidiaries, participated in 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. Patient-related accounts receivable (the “Receivables”) for certain affiliated hospitals served as collateral for the outstanding borrowings under the Receivables Facility. The interest rate on the borrowings was based on the commercial paper rate plus an applicable interest rate spread. The Receivables Facility was repaid in full and terminated upon the effectiveness of the ABL Facility on April 3, 2018.

Loss (Gain) from Early Extinguishment of Debt

There was no loss on early extinguishment of debt for the three months ended June 30, 2019. The financing and repayment transactions discussed above resulted in a gain from early extinguishment of debt of $64 million for the three months ended June 30, 2018, andafter-tax gain of $50 million for the three months ended June 30, 2018. The financing and repayment transactions discussed above resulted in a loss from early extinguishment of debt of $31 million and a gain from early extinguishment of debt of $59 million for the six months ended June 30, 2019 and 2018, respectively, and anafter-tax loss of $23 million and anafter-tax gain of $46 million for the six months ended June 30, 2019 and 2018, respectively.

Other Debt

As of June 30, 2019, other debt consisted primarily of other obligations maturing in various installments through 2028.

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 three separate1 interest swap agreements in effect atagreement with a notional amount of approximately $300 million as of June 30, 2019, with an aggregate notional amount for currently effective swaps of $700 million. On each of these swaps, the2020. The Company receives a variable rate of interest on this swap based on the three-month LIBOR in exchange for the payment of a fixed rate of interest. See Note 117 for additional information regarding these swaps.this swap.

The Company paid interest of $117$222 million and $274$117 million on borrowings during the three months ended June 30, 20192020 and 2018,2019, respectively, and $318$486 million and $486$318 million on borrowings during the six months ended June 30, 2020 and 2019, and 2018, respectively.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

11.7.  FAIR VALUE OF FINANCIAL INSTRUMENTS

The fair value of financial instruments has been estimated by the Company using available market information as of June 30, 20192020 and December 31, 2018,2019, and valuation methodologies considered appropriate. The estimates presented in the table below are not necessarily indicative of amounts the Company could realize in a current market exchange (in millions):

 

   June 30, 2019  December 31, 2018
   Carrying  Estimated Fair  Carrying  Estimated Fair
   Amount  Value  Amount  Value

Assets:

        

Cash and cash equivalents

  $            207   $207   $            196   $196 

Investments in equity securities

   136    136    137    137 

Available-for-sale securities

   99    99    93    93 

Trading securities

   12    12    11    11 

Liabilities:

        

Contingent Value Right

   -    -    -    - 

Credit Facility

   -    -    1,602    1,564 

8% Senior Notes due 2019

   155    152    155    146 

718% Senior Notes due 2020

   121    112    121    100 

518% Senior Secured Notes due 2021

   986    988    984    934 

678% Senior Notes due 2022

   2,599    1,773    2,593    1,175 

614% Senior Secured Notes due 2023

   3,071    2,990    3,067    2,819 

858% Senior Secured Notes due 2024

   1,022    1,039    1,021    1,025 

8% Senior Secured Notes due 2026

   1,572    1,544    -    - 

Junior-Priority Secured Notes due 2023

   1,752    1,442    1,750    1,380 

Junior-Priority Secured Notes due 2024

   1,339    1,017    1,338    976 

ABL Facility and other debt

   763    763    734    734 

 

 

June 30, 2020

 

 

December 31, 2019

 

 

 

Carrying

 

 

Estimated

Fair

 

 

Carrying

 

 

Estimated

Fair

 

 

 

Amount

 

 

Value

 

 

Amount

 

 

Value

 

Assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

1,552

 

 

$

1,552

 

 

$

216

 

 

$

216

 

Investments in equity securities

 

 

124

 

 

 

124

 

 

 

141

 

 

 

141

 

Available-for-sale debt securities

 

 

107

 

 

 

107

 

 

 

101

 

 

 

101

 

Trading securities

 

 

12

 

 

 

12

 

 

 

12

 

 

 

12

 

Liabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5⅛% Senior Secured Notes due 2021

 

 

 

 

 

 

 

 

990

 

 

 

1,003

 

6⅞% Senior Notes due 2022

 

 

230

 

 

 

190

 

 

 

229

 

 

 

188

 

6¼% Senior Secured Notes due 2023

 

 

2,655

 

 

 

2,521

 

 

 

3,074

 

 

 

3,148

 

8⅝% Senior Secured Notes due 2024

 

 

1,024

 

 

 

1,012

 

 

 

1,023

 

 

 

1,099

 

6⅝% Senior Secured Notes due 2025

 

 

1,423

 

 

 

1,388

 

 

 

 

 

 

 

8% Senior Secured Notes due 2026

 

 

2,072

 

 

 

1,992

 

 

 

2,070

 

 

 

2,182

 

8% Senior Secured Notes due 2027

 

 

691

 

 

 

669

 

 

 

691

 

 

 

700

 

6⅞% Senior Notes due 2028

 

 

1,679

 

 

 

687

 

 

 

1,678

 

 

 

1,700

 

9⅞% Junior-Priority Secured Notes due 2023

 

 

1,756

 

 

 

1,420

 

 

 

1,754

 

 

 

1,539

 

8⅛% Junior-Priority Secured Notes due 2024

 

 

1,342

 

 

 

944

 

 

 

1,340

 

 

 

1,113

 

ABL Facility and other debt

 

 

23

 

 

 

23

 

 

 

285

 

 

 

285

 

The carrying value of the Company’s long-term debt in the above table is presented net of unamortized deferred debt issuance costs. 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 12.8. 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 or through publicly available subscription services such as Bloomberg to determine fair values 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).

Investments in equity securities. Estimated fair value is based on closing price as quoted in public markets. Prior to the adoption of ASU2016-01 on January 1, 2018, such investments were classified as eitheravailable-for-sale or trading

Available-for-sale debt securities.

Available-for-sale securities.  Estimated fair value is based on closing price as quoted in public markets or other various valuation techniques.

Trading securities.  Estimated fair value is based on closing price as quoted in public markets.

Contingent Value Right. Estimated fair value is based on the closing price as quoted on the public market where the CVR is traded.

Credit Facility. Estimated fair value is based on publicly available trading activity and supported with information from the Company’s bankers regarding relevant pricing for trading activity among the Company’s lending institutions.

8%5⅛% Senior Secured Notes due 2019.2021.  Estimated fair value is based on the closing market price for these notes.

71818


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

6⅞% Senior Notes due 2020.2022.  Estimated fair value is based on the closing market price for these notes.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

518% Senior Secured Notes due 2021.2023.  Estimated fair value is based on the closing market price for these notes.

6788⅝% Senior Secured Notes due 2022.2024. Estimated fair value is based on the closing market price for these notes.

6146⅝% Senior Secured Notes due 2023.2025.  Estimated fair value is based on the closing market price for these notes.

858%8% Senior Secured Notes due 2024.2026. Estimated fair value is based on the closing market price for these notes.

8% Senior Secured Notes due 2026.2027. Estimated fair value is based on the closing market price for these notes.

6⅞% Senior Secured Notes due 2028. Estimated fair value is based on the closing market price for these notes.

9⅞%Junior-Priority Secured Notes due 2023. Estimated fair value is based on the closing market price for these notes.

8⅛%Junior-Priority Secured Notes due 2024. Estimated fair value is based on the closing market price for these notes.

ABL Facility and other debt.  The carrying amount of the ABL Facility and all other debt approximates fair value due to the nature of these obligations.

Interest rate swaps.  The fair value of the interest rate swap agreementsagreement is the amount at which theyit 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

At June 30, 2020, the Company incorporates credit valuation adjustments (“CVAs”) to appropriately reflect both its own nonperformance or credit riskhad 1 interest rate swap with a notional amount of approximately $300 million, a fixed interest rate of 2.892%, a termination date of August 30, 2020, and the respective counterparty’s nonperformance or credit risk in the fair value measurements. In adjusting thea 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.

approximately $1 million. The Company assesses the effectiveness of its hedge instruments on a quarterly basis. For the six months ended June 30, 2019 and 2018, 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 condensed consolidated financial position, operations or cash flows. The counterpartiescounterparty to the interest rate swap agreements exposeagreement exposes the Company to credit risk in the event of nonperformance by such counterparties.counterparty. However, at June 30, 2019,2020, the Company does not anticipate nonperformance by these counterparties.the counterparty. The Company does not hold or issue derivative financial instruments for trading purposes.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Interest rate swaps consisted of the following at June 30, 2019:

              Asset (Liability) 
     Notional Amount            Fair Value 

            Swap #             

  (in millions)     Fixed Interest Rate     

Termination Date

  (in millions) 
1  $200      2.515 %     August 30, 2019  $-   
2   200      2.613 %     August 30, 2019   -   
3   300      2.892 %     August 30, 2020   (3)   

The Company is exposed to certain risks relating to its ongoing business operations. The risk managed by using derivative instruments is interest rate risk. 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 interest rates in effect as of June 30, 2019, approximately $22020, less than $1 million of interest income resulting from the spread between the fixed and floating rates defined in eachthe 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.its termination date of August 30, 2020.

The following tabular disclosure provides the amount ofpre-tax gain (loss) gain recognized as a component of OCI during the three and six months ended June 30, 20192020 and 20182019 (in millions):

 

  Amount of Pre-Tax (Loss) Gain Recognized in OCI (Effective  Portion) 
Derivatives in Cash Flow Hedging Three Months Ended June 30,  Six Months Ended June 30, 

Relationships

         2019                  2018                  2019                  2018         

Interest rate swaps

 $(1)  $6    $(3)  $23   

The following tabular disclosure provides the location of the effective portion of thepre-tax loss (gain) reclassified from accumulated other comprehensive loss (“AOCL”) into interest expense on the condensed consolidated statements of loss during the three and six months ended June 30, 2019 and 2018 (in millions):

 

  Amount ofPre-Tax Loss (Gain) Reclassified 
  from AOCL into Income (Effective Portion) 
Location of Loss (Gain) Reclassified from Three Months Ended June 30,  Six Months Ended June 30, 

AOCL into Income (Effective Portion)

         2019                        2018                          2019                          2018             

Interest expense, net

 $-    $2    $(1)  $7   

 

 

Amount of Pre-Tax Gain (Loss) Recognized in OCI

(Effective Portion)

 

Derivatives in Cash Flow Hedging

 

Three Months Ended

June 30,

 

 

Six Months Ended

June 30,

 

Relationships

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Interest rate swaps

 

$

1

 

 

$

(1

)

 

$

 

 

$

(3

)

19


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

The following tabular disclosure provides the location of the effective portion of the pre-tax loss (gain) reclassified from accumulated other comprehensive loss (“AOCL”) into interest expense on the condensed consolidated statements of income (loss) during the three and six months ended June 30, 2020 and 2019 (in millions):

 

 

Amount of Pre-Tax Loss (Gain) Reclassified

 

 

 

from AOCL into Income (Effective Portion)

 

Location of Loss (Gain) Reclassified from

 

Three Months Ended

June 30,

 

 

Six Months Ended

June 30,

 

AOCL into Income (Effective Portion)

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Interest expense, net

 

$

 

 

$

 

 

$

1

 

 

$

(1

)

 

The fair values of derivative instruments in the condensed consolidated balance sheets as of June 30, 20192020 and December 31, 20182019 were as follows (in millions):

 

   Asset Derivatives   Liability Derivatives 
       June 30, 2019           December 31, 2018           June 30, 2019           December 31, 2018     
   Balance      Balance      Balance      Balance    
   Sheet      Sheet      Sheet      Sheet    
   Location  Fair Value   Location  Fair Value   Location  Fair Value   Location  Fair Value 

Derivatives designated as hedging instruments

  Other
assets,
net
  $-   Other
assets,
net
  $3   Other
long-term
liabilities
  $3   Other
long-term
liabilities
  $2 

 

 

Asset Derivatives

 

 

Liability Derivatives

 

 

 

June 30, 2020

 

 

December 31, 2019

 

 

June 30, 2020

 

 

December 31, 2019

 

 

 

Balance

 

 

 

 

 

Balance

 

 

 

 

 

Balance

 

 

 

 

 

Balance

 

 

 

 

 

 

Sheet

 

Fair

 

 

Sheet

 

Fair

 

 

Sheet

 

Fair

 

 

Sheet

 

Fair

 

 

 

Location

 

Value

 

 

Location

 

Value

 

 

Location

 

Value

 

 

Location

 

Value

 

Derivatives designated as hedging

   instruments

 

Other assets, net

 

$

 

 

Other assets, net

 

$

 

 

Other long-term liabilities

 

$

1

 

 

Other long-term liabilities

 

$

2

 

12.

8.  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).

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 1:

Quoted market prices in active markets for identical

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.

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. Transfers between levels within the fair value hierarchy are recognized by the Company on the date of the change in circumstances that requires such transfer. There were no0 transfers between levels during thesix-month periods ended June 30, 20192020 or June 30, 2018.

2019.

20


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

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 June 30, 20192020 and December 31, 20182019 (in millions):

 

      June 30, 2019               Level 1                   Level 2                   Level 3         

 

June 30,

2020

 

 

Level 1

 

 

Level 2

 

 

Level 3

 

Investments in equity securities

  $136     $136     $-     $-   

 

$

124

 

 

$

124

 

 

$

 

 

$

 

Available-for-sale securities

   99      -      99      -   

Available-for-sale debt securities

 

 

107

 

 

 

 

 

 

107

 

 

 

 

Trading securities

   12      -      12      -   

 

 

12

 

 

 

 

 

 

12

 

 

 

 

Fair value of interest rate swap agreements

   -      -      -      -   
  

 

   

 

   

 

   

 

 

Total assets

  $247     $136     $111     $-   

 

$

243

 

 

$

124

 

 

$

119

 

 

$

 

  

 

   

 

   

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fair value of interest rate swap agreements

  $3     $-     $3     $-   
  

 

   

 

   

 

   

 

 

Fair value of interest rate swap agreement

 

$

1

 

 

$

 

 

$

1

 

 

$

 

Total liabilities

  $3     $-     $3     $-   

 

$

1

 

 

$

 

 

$

1

 

 

$

 

  

 

   

 

   

 

   

 

 
  December 31, 2018   Level 1   Level 2   Level 3 

Investments in equity securities

  $137     $137     $-     $-   

Available-for-sale securities

   93      -      93      -   

Trading securities

   11      -      11      -   

Fair value of interest rate swap agreements

   3      -      3      -   
  

 

   

 

   

 

   

 

 

Total assets

  $244     $137     $107     $-   
  

 

   

 

   

 

   

 

 

Contingent Value Right (CVR)

  $-     $-     $-     $-   

Fair value of interest rate swap agreements

   2      -      2      -   
  

 

   

 

   

 

   

 

 

Total liabilities

  $2     $-     $2     $-   
  

 

   

 

   

 

   

 

 

 

 

December 31,

2019

 

 

Level 1

 

 

Level 2

 

 

Level 3

 

Investments in equity securities

 

$

141

 

 

$

141

 

 

$

 

 

$

 

Available-for-sale debt securities

 

 

101

 

 

 

 

 

 

101

 

 

 

 

Trading securities

 

 

12

 

 

 

 

 

 

12

 

 

 

 

Total assets

 

$

254

 

 

$

141

 

 

$

113

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fair value of interest rate swap agreement

 

$

2

 

 

$

 

 

$

2

 

 

$

 

Total liabilities

 

$

2

 

 

$

 

 

$

2

 

 

$

 

Investments in Equity Securities,Available-for-sale Available-for-Sale Debt Securities and Trading Securities

Investments in equity securities and trading securities classified as Level 1 are measured using quoted market prices. Level 2available-for-sale debt securities and trading securities primarily consisted of bonds and notes issued by the United States government and its agencies and domestic and foreign corporations. The estimated fair values of these securities are determined using various valuation techniques, including a multi-dimensional relational model that incorporates standard observable inputs and assumptions such as benchmark yields, reported trades, broker/dealer quotes, issuer spreads, benchmark securities, bids/offers and other pertinent reference data.

Contingent Value Right (CVR)

The CVRs represented the estimate of the fair value for the contingent consideration paid to HMA shareholders as part of the HMA merger. The CVRs were listed on the Nasdaq and the valuation of the CVRs was based on the quoted trading price for the CVRs on the last day of the period. Changes in the estimated fair value of the CVRs were recorded through the condensed consolidated statements of loss. In January 2019, the CVRs were terminated and removed from listing with Nasdaq after the determination that no amount was payable under the CVR agreement.

Fair Value of Interest Rate Swap AgreementsAgreement

The valuation of the Company’s interest rate swap agreementsagreement 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 areagreement is 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.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

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 had an immaterial effect on the fair value of the related asset or liability at June 30, 2019 and December 31, 2018.

The majority of the inputs used to value the Company’s interest rate swap agreements,agreement, 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 arevaluation is classified in Level 2 of the fair value hierarchy.

13.21


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

9.  LEASES

The Company utilizes operating and finance leases for the use of certain hospitals, medical office buildings, and medical equipment. All lease agreements generally requireThe Company has elected to account for COVID-19 related concessions as though the Company to pay maintenance, repairs, property taxesenforceable rights and insurance costs, whichobligations for those concessions are variable amounts based on actual costs incurred during each applicable period. Such costs are not included in the determination of the ROU asset or lease liability. Variable lease cost also includes escalating rent payments that are not fixed at commencement but are based on an index that is determined in future periods over the lease term based on changes in the Consumer Price Index or other measure of cost inflation. Most leases include one or more options to renew the lease at the end of the initial term, with renewal terms that generally extend the lease at the then market rate of rental payment. Certain leases also include an option to buyexplicit within the underlying asset at orcontract. During the three and six months ended June 30, 2020, concessions of approximately $1 million were recognized as a short time priorreduction to the termination of the lease. All such options are at the Company’s discretion and are evaluated at the commencement of the lease, with only those that are reasonably certain of exercise included in determining the appropriate lease term. variable rent expense.

The components of lease cost and rent expense for the three and six months ended June 30, 2020 and 2019 are as follows (in millions):

 

        Three Months Ended             Six Months Ended      

 

Three Months Ended

June 30,

 

 

Six Months Ended

June 30,

 

Lease Cost

  June 30, 2019 June 30, 2019

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Operating lease cost:

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Operating lease cost

  $48  $95 

 

$

51

 

 

$

48

 

 

$

101

 

 

$

95

 

Short-term rent expense

   27  59 

 

 

27

 

 

 

27

 

 

 

54

 

 

 

59

 

Variable lease cost

   7  10 

 

 

6

 

 

 

7

 

 

 

11

 

 

 

10

 

Sublease income

   (1 (2

 

 

(2

)

 

 

(1

)

 

 

(3

)

 

 

(2

)

  

 

 

 

Total operating lease cost

  $                                81  $                          162 

 

$

82

 

 

$

81

 

 

$

163

 

 

$

162

 

  

 

 

 

Finance lease cost:

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amortization ofright-of-use assets

  $3  $6 

 

$

3

 

 

$

3

 

 

$

6

 

 

$

6

 

Interest on finance lease liabilities

   2  4 

 

 

2

 

 

 

2

 

 

 

4

 

 

 

4

 

  

 

 

 

Total finance lease cost

  $5  $10 

 

$

5

 

 

$

5

 

 

$

10

 

 

$

10

 

  

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

 

Supplemental balance sheet information related to leases was as follows (in millions):

 

  

Balance Sheet Classification

      June 30, 2019     

 

Balance Sheet Classification

 

June 30, 2020

 

 

December 31, 2019

 

Operating Leases:

    

 

 

 

 

 

 

 

 

 

 

Operating Lease ROU Assets

  

Other assets, net

  $603 

 

Other assets, net

 

$

623

 

 

$

607

 

 

 

 

 

 

 

 

 

 

 

Finance Leases:

    

 

 

 

 

 

 

 

 

 

 

Finance Lease ROU Assets

  

Property and equipment

   184 

 

Property and equipment

 

 

 

 

 

 

 

 

Accumulated amortization

  

Accumulated depreciation and amortization

   (59

 

Land and improvements

 

$

8

 

 

$

8

 

 

Buildings and improvements

 

 

136

 

 

 

154

 

 

Equipment and fixtures

 

 

9

 

 

 

11

 

 

Property and equipment

 

 

153

 

 

 

173

 

 

Less accumulated depreciation and amortization

 

 

(46

)

 

 

(56

)

 

Property and equipment, net

 

$

107

 

 

$

117

 

 

 

 

 

 

 

 

 

 

 

Current finance lease liabilities

  

Current maturities of long-term debt

   8 

 

Current maturities of long-term debt

 

$

5

 

 

$

6

 

Long-term finance lease liabilities

  

Long-term debt

   118 

 

Long-term debt

 

 

76

 

 

 

107

 

22


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

Supplemental cash flow and other information related to leases as of and for the six months ended June 30, 2019 are as follows (dollars in millions):

         Six Months Ended       

Other information

  June 30, 2019 

Cash paid for amounts included in the measurement of lease liabilities:

  

Operating cash flows from operating leases

  $78 

Operating cash flows from finance leases

   4 

Financing cash flows from finance leases

   5 

Right-of-use assets obtained in exchange for new finance lease liabilities

   1 

Right-of-use assets obtained in exchange for new operating lease liabilities

   47 

Weighted-average remaining lease term:

  

Operating leases

   6 years 

Finance leases

   20 years 

Weighted-average discount rate:

  

Operating leases

   9.3 

Finance leases

   5.7 

On December 22, 2016, the Company completed the sale2020 and leaseback of ten medical office buildings for net proceeds of $159 million to HCP, Inc. The buildings, with a combined total of 756,183 square feet, are located in five states and support a wide array of diagnostic, medical and surgical services in an outpatient setting for the respective nearby hospitals. Because of the Company’s continuing involvement in these leased buildings, the transaction did not qualify for sale treatment and the related leases have been recorded as financing obligations in the Company’s condensed consolidated balance sheet at December 31, 2018. Upon adoption of ASC 842 on January 1, 2019 the Company reevaluated the classification of these financing arrangements utilizing the new accounting requirements for sale-leasebacks in ASC 842, concluding that these financing arrangements continue to not qualify for sale treatment and therefore should continue to be classified as financing obligations. At June 30, 2019, six of these financing obligations remain outstanding and are included in the table below, with the other four medical office buildings having been divested in conjunction with the sale of the related hospital entity.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Commitments relating to noncancellable operating and finance leases and financing obligations for each of the next five years and thereafter are as follows (in millions):

 

       Financing

Year Ending December 31,

          Operating                 Finance             Obligations    

2019 (remaining six months)

   $104   $7   $4 

2020

   165   13   7 

2021

   123   11   7 

2022

   100   10   7 

2023

   80   16   7 

Thereafter

   243   166   120 
  

 

 

 

 

 

 

 

 

 

 

 

Total minimum future payments

   815   223   152 

Less: Imputed interest

   (203  (97  (51
  

 

 

 

 

 

 

 

 

 

 

 

Total liabilities

   612   126   101 

Less: Current portion

   (133  (8  (3
  

 

 

 

 

 

 

 

 

 

 

 

Long-term liabilities

   $                  479   $                  118   $              98 
  

 

 

 

 

 

 

 

 

 

 

 

 

As previously disclosed in our 2018 Annual Report on Form10-K, which followed the lease accounting prior to adoption of ASC 842, future commitments relating to noncancellable operating and capital leases and financing obligations for the five years and period thereafter as of December 31, 2018 were as follows (in millions):

 

 

       Financing

Year Ending December 31,

        Operating (1)                 Capital               Obligations    

2019

   $188   $12   $12 

2020

   157   10   9 

2021

   121   8   10 

2022

   98   7   10 

2023

   79   14   10 

Thereafter

   234   121   106 
  

 

 

 

 

 

 

 

 

 

 

 

Total minimum future payments

   $877   172   157 
  

 

 

 

  

Less: Imputed interest

    (80  (18
   

 

 

 

 

 

 

 

Total capital lease and financing obligations

    92   139 

Less: Current portion

    (8  (5
   

 

 

 

 

 

 

 

Long-term capital lease and financing obligations

    $84   $134 
   

 

 

 

 

 

 

 

 

 

Six Months Ended

June 30,

 

Cash flow information

 

2020

 

 

2019

 

Cash paid for amounts included in the measurement of lease liabilities:

 

 

 

 

 

 

 

 

Operating cash flows from operating leases (1)

 

$

95

 

 

$

78

 

Operating cash flows from finance leases

 

 

4

 

 

 

4

 

Financing cash flows from finance leases

 

 

4

 

 

 

5

 

Right-of-use assets obtained in exchange for new finance lease liabilities

 

 

21

 

 

 

1

 

Right-of-use assets obtained in exchange for new operating lease liabilities

 

 

73

 

 

 

47

 

(1)      Minimum lease payments have not been reduced by minimum sublease rentals due in the future, which are considered immaterial.

As of June 30, 2019, there were approximately $14 million of assets underlying approved but pending leases that have not yet commenced, primarily for medical equipment.

(1)

Included in the change in other operating assets and liabilities in the condensed consolidated statement of cash flows.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

 

14.10.  EMPLOYEE BENEFIT PLANS

The Company provides an unfunded Supplemental Executive Retirement Plan (“SERP”) for certain members of its executive management. The Company uses a December 31 measurement date for the benefit obligations and a January 1 measurement date for its net periodic costs for the SERP. Variances from actuarially assumed rates will result in increases or decreases in benefit obligations and net periodic cost in future periods. Benefits expense under the SERP was $2 million for both of the three-month periods ended June 30, 2020 and 2019, and 2018,$4 million and $3 million and $4 million during the six months ended June 30, 20192020 and 2018,2019, respectively. The accrued benefit liability for the SERP totaled $69$76 million and $66$72 million at June 30, 20192020 and December 31, 2018,2019, respectively, and is included in other long-term liabilities on the condensed consolidated balance sheets. The weighted-average assumptions used in determining net periodic cost for the six months ended June 30, 20192020 and June 30, 20182019 were a discount rate of 4.2%3.1% and 3.4%4.2%, respectively, and an annual salary increase of 3.0% and 2.0%, respectively.. The Company had equity investment securities in a rabbi trust generally designated to pay benefits of the SERP in the amounts of $80$85 million and $74$84 million at June 30, 20192020 and December 31, 2018,2019, respectively. These amounts are included in other assets, net on the condensed consolidated balance sheets.

During 2018, certain members of executive management11.  STOCKHOLDERS’ DEFICIT

Authorized capital shares of the Company thatinclude 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, NaN of which were participantsoutstanding as of June 30, 2020, 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.

The Company is a holding company which operates through its subsidiaries. The Company’s ABL Facility and the indentures governing each series of the Company’s outstanding notes contain various covenants under which the assets of the subsidiaries of the Company are subject to certain restrictions relating to, among other matters, dividends and distributions, as referenced in the SERP retiredparagraph below.

The ABL Facility and met the requirements for payoutindentures governing each series of their SERP retirement benefit. The SERP payout provisions require paymentthe Company’s outstanding notes restrict the Company’s subsidiaries from, among other matters, paying dividends and making distributions to the participantCompany, which thereby limits the Company’s ability to pay dividends and/or repurchase stock. As of June 30, 2020, under the most restrictive test in an actuarially determined lump sum amount six months afterthese agreements (and subject to certain exceptions), the participant retires fromCompany has approximately $200 million of capacity to pay permitted dividends and/or repurchase shares of stock or make other restricted payments.

23


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

The following schedule presents the Company. Such amounts were paid outreconciliation of the rabbi trust. As required by the pension accounting rules in U.S. GAAP,carrying amount of total equity, equity attributable to the Company, recognizedand equity attributable to the noncontrolling interests as of June 30, 2020, and during each of the three-month periods following December 31, 2019 (in millions):

 

 

 

 

 

 

 

Community Health Systems, Inc. Stockholders

 

 

 

 

 

 

 

 

 

 

 

Redeemable

Noncontrolling

Interest

 

 

 

Common

Stock

 

 

Additional

Paid-In

Capital

 

 

Accumulated

Other

Comprehensive

Loss (Income)

 

 

Accumulated

Deficit

 

 

Noncontrolling

Interest

 

 

Total

Stockholders’

Deficit

 

Balance, December 31, 2019

 

$

502

 

 

 

$

1

 

 

$

2,008

 

 

$

(9

)

 

$

(4,218

)

 

$

77

 

 

$

(2,141

)

Comprehensive income

 

 

8

 

 

 

 

 

 

 

 

 

 

2

 

 

 

18

 

 

 

8

 

 

 

28

 

Distributions to noncontrolling interests

 

 

(22

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(8

)

 

 

(8

)

Purchase of subsidiary shares from noncontrolling

   interests

 

 

(1

)

 

 

 

 

 

 

(1

)

 

 

 

 

 

 

 

 

 

 

 

(1

)

Other reclassifications of noncontrolling interests

 

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(8

)

 

 

(8

)

Adjustment to redemption value of redeemable

   noncontrolling interests

 

 

7

 

 

 

 

 

 

 

(7

)

 

 

 

 

 

 

 

 

 

 

 

(7

)

Cancellation of restricted stock for tax withholdings

   on vested shares

 

 

 

 

 

 

 

 

 

(1

)

 

 

 

 

 

 

 

 

 

 

 

(1

)

Share-based compensation

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

2

 

Balance, March 31, 2020

 

 

502

 

 

 

 

1

 

 

 

2,001

 

 

 

(7

)

 

 

(4,200

)

 

 

69

 

 

 

(2,136

)

Comprehensive income

 

 

7

 

 

 

 

 

 

 

 

 

 

2

 

 

 

69

 

 

 

16

 

 

 

87

 

Distributions to noncontrolling interests

 

 

(17

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(10

)

 

 

(10

)

Purchase of subsidiary shares from noncontrolling

   interests

 

 

(1

)

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

1

 

Other reclassifications of noncontrolling interests

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjustment to redemption value of redeemable

   noncontrolling interests

 

 

(3

)

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

3

 

Share-based compensation

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

3

 

Balance, June 30, 2020

 

$

489

 

 

 

$

1

 

 

$

2,008

 

 

$

(5

)

 

$

(4,131

)

 

$

75

 

 

$

(2,052

)

24


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

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 as of June 30, 2019, and during each of the three-month periods following December 31, 2018 (in millions):

 

 

 

 

 

 

 

Community Health Systems, Inc. Stockholders

 

 

 

 

 

 

 

 

 

 

 

Redeemable

Noncontrolling

Interest

 

 

 

Common

Stock

 

 

Additional

Paid-In

Capital

 

 

Accumulated

Other

Comprehensive

Loss

 

 

Accumulated

Deficit

 

 

Noncontrolling

Interest

 

 

Total

Stockholders’

Deficit

 

Balance, December 31, 2018

 

$

504

 

 

 

$

1

 

 

$

2,017

 

 

$

(10

)

 

$

(3,543

)

 

$

72

 

 

$

(1,463

)

Comprehensive income (loss)

 

 

9

 

 

 

 

 

 

 

 

 

 

(118

)

 

 

8

 

 

 

(110

)

Contributions from noncontrolling interests

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Distributions to noncontrolling interests

 

 

(19

)

 

 

 

 

 

 

 

 

 

 

 

(8

)

 

 

(8

)

Purchase of subsidiary shares from noncontrolling

   interests

 

 

(1

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Other reclassifications of noncontrolling interests

 

 

(1

)

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

1

 

Adjustment to redemption value of redeemable

   noncontrolling interests

 

 

12

 

 

 

 

 

 

(12

)

 

 

 

 

 

 

 

 

(12

)

Cancellation of restricted stock for tax withholdings

   on vested shares

 

 

 

 

 

 

 

(1

)

 

 

 

 

 

 

 

 

(1

)

Share-based compensation

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

3

 

Balance, March 31, 2019

 

 

505

 

 

 

 

1

 

 

 

2,007

 

 

 

(10

)

 

 

(3,661

)

 

 

73

 

 

 

(1,590

)

Comprehensive income (loss)

 

 

14

 

 

 

 

 

 

 

 

2

 

 

 

(167

)

 

 

8

 

 

 

(157

)

Contributions from noncontrolling interests

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Distributions to noncontrolling interests

 

 

(22

)

 

 

 

 

 

 

 

 

 

 

 

(8

)

 

 

(8

)

Purchase of subsidiary shares from noncontrolling

   interests

 

 

 

 

 

 

 

(1

)

 

 

 

 

 

 

 

 

(1

)

Other reclassifications of noncontrolling interests

 

 

(1

)

 

 

 

 

 

(1

)

 

 

 

 

 

 

1

 

 

 

Adjustment to redemption value of redeemable

   noncontrolling interests

 

 

6

 

 

 

 

 

 

(6

)

 

 

 

 

 

 

 

 

(6

)

Share-based compensation

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

3

 

Balance, June 30, 2019

 

$

503

 

 

 

$

1

 

 

$

2,002

 

 

$

(8

)

 

$

(3,828

)

 

$

74

 

 

$

(1,759

)

25


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

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’ deficit (in millions):

 

 

Three Months Ended

 

 

Six Months Ended

 

 

 

June 30,

 

 

June 30,

 

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Net income (loss) attributable to Community Health Systems,

   Inc. stockholders

 

$

70

 

 

$

(167

)

 

$

87

 

 

$

(285

)

Transfers to the noncontrolling interests:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net increase (decrease) in Community Health Systems,

   Inc. paid-in-capital for purchase of

   subsidiary partnership interests

 

 

1

 

 

 

(1

)

 

 

 

 

 

(1

)

Net transfers to the noncontrolling interests

 

 

1

 

 

 

(1

)

 

 

 

 

 

(1

)

Change to Community Health Systems, Inc. stockholders'

   deficit from net income (loss) attributable to

   Community Health Systems, Inc. stockholders and

   transfers to noncontrolling interests

 

$

71

 

 

$

(168

)

 

$

87

 

 

$

(286

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.  EARNINGS PER SHARE

The following table sets forth the components of the denominator for the computation of basic and diluted earnings per share for net income (loss) attributable to Community Health Systems, Inc. common stockholders:

 

 

Three Months Ended

 

 

Six Months Ended

 

 

 

June 30,

 

 

June 30,

 

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Weighted-average number of shares outstanding — basic

 

 

114,972,408

 

 

 

113,862,097

 

 

 

114,636,963

 

 

 

113,561,523

 

Effect of dilutive securities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Restricted stock awards

 

 

41,253

 

 

 

 

 

59,295

 

 

 

Employee stock options

 

 

 

 

 

 

 

238

 

 

 

Other equity-based awards

 

 

 

 

 

 

 

 

Weighted-average number of shares outstanding — diluted

 

 

115,013,661

 

 

 

113,862,097

 

 

 

114,696,496

 

 

 

113,561,523

 

The Company generated a loss of $1 million duringattributable to Community Health Systems, Inc. common stockholders for the three and six months ended June 30, 2018. There was no settlement loss2019, so the effect of dilutive securities is not considered because their effect would be antidilutive. If the Company had generated income during the three and six months ended June 30, 2019.2019, the effect of restricted stock awards, employee stock options, and other equity-based awards on the diluted shares calculation would have been an increase in shares of 30,472 and 44,867, respectively.

15.

 

 

Three Months Ended

 

 

Six Months Ended

 

 

 

June 30,

 

 

June 30,

 

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Dilutive securities outstanding not included in the computation

   of earnings per share because their effect is antidilutive:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee stock options and restricted stock awards

 

 

4,323,656

 

 

 

4,020,947

 

 

 

4,587,414

 

 

 

3,908,725

 

26


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

13.  CONTINGENCIES

The Company is a party to various legal, regulatory and governmental proceedings incidental to its business. Based on current knowledge, management does not believe that loss contingencies arising from pending legal, regulatory and governmental matters, including the matters described herein, will have a material adverse effect on the condensed consolidated financial position or liquidity of the Company. However, in light of the inherent uncertainties involved in pending legal, regulatory and governmental matters, some of which are beyond the Company’s control, and the very large or indeterminate damages sought in some of these matters, an adverse outcome in one or more of these matters could be material to the Company’s results of operations or cash flows for any particular reporting period.

With respect to all legal, regulatory and governmental proceedings, the Company considers the likelihood of a negative outcome. If the Company determines the likelihood of a negative outcome with respect to any such matter is probable and the amount of the loss can be reasonably estimated, the Company records an accrual for the estimated loss for the expected outcome of the matter. If the likelihood of a negative outcome with respect to material matters is reasonably possible and the Company is able to determine an estimate of the possible loss or a range of loss, whether in excess of a related accrued liability or where there is no accrued liability, the Company discloses the estimate of the possible loss or range of loss. However, the Company is unable to estimate a possible loss or range of loss in some instances based on the significant uncertainties involved in, and/or the preliminary nature of, certain legal, regulatory and governmental matters.

In connection with thespin-off of Quorum Health Corporation (“QHC”), the Company agreed to indemnify QHC for certain liabilities relating to outcomes or events occurring prior to April 29, 2016, the closing date of thespin-off, including (i) certain claims and proceedings that were known to be outstanding at or prior to the consummation of thespin-off and involved multiple facilities and (ii) certain claims, proceedings and investigations by governmental authorities or private plaintiffs related to activities occurring at or related to QHC’s healthcare facilities prior to the closing date of thespin-off, but only to the extent, in the case of clause (ii), that such claims are covered by insurance policies maintained by the Company, including professional liability and employer practices. Notwithstanding the foregoing, the Company is not required to indemnify QHC in respect of any claims or proceedings arising out of or related to the business operations of Quorum Health Resources, LLC at any time or QHC’s compliance with the corporate integrity agreement. Subsequent to thespin-off of QHC, the Office of the Inspector General provided the Company with written assurance that it would look solely at QHC for compliance for its facilities under the Company’s Corporate Integrity Agreement; however, the Office of the Inspector General declined to enter into a separate corporate integrity agreement with QHC.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)Probable Contingencies

 

Probable Contingencies

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, which was dismissed by the agency and was appealed to an administrative law judge for a hearing that occurred on January19-26, 2016. In a decision dated November 9, 2016, the law judge awarded Becker approximately $1.9 million for front pay, back pay and emotional damages with attorney fees to be later determined. The Company has appealed the award to the Administrative Review Board and is awaiting its decision. At a hearing on July 27, 2012, the trial court dismissed Community Health Systems, Inc. from the state case and subsequently certified the state case for an interlocutory appeal of the denial to dismiss his employer and the management company. The appellate court accepted the interlocutory appeal, and it was argued on April 30, 2014. On August 14, 2014, the court denied the Company’s appeal. On October 20, 2014, the Company filed a petition to review the denial with the Washington Supreme Court. The appeal was accepted and oral argument was heard on June 9, 2015. On September 15, 2015, the court denied the Company’s appeal and remanded to the trial court; a previous trial setting of September 12, 2016 has been vacated and not reset. The Company continues to vigorously defend these actions.

The table below presents a reconciliation of the beginning and ending liability balances (in millions) during the six months ended June 30, 2019, with respect to the Company’s determination of the contingencies of the Company in respect of which an accrual has been recorded.

Summary of Recorded Amounts

Probable
        Contingencies        

Balance as of December 31, 2018

  $19

Expense

3

Reserve for insured claim

-

Cash payments

(5

Balance as of June 30, 2019

  $                        17

In accordance with applicable accounting guidance, the Company establishes a liability for litigation, regulatory and governmental matters for which, based on information currently available, the Company believes that a negative outcome is known or is probable and the amount of the loss is reasonably estimable. For all such matters (whether or not discussed in this contingencies footnote), such amounts have been recorded in other accrued liabilities on the condensed consolidated balance sheet and are included in the table above. Due to the uncertainties and difficulty in predicting the ultimate resolution of these contingencies, the actual amount could differ from the estimated amount reflected as a liability on the condensed consolidated balance sheet.

In the aggregate, attorneys’ fees and other costs incurred but not included in the table above related to probable contingencies, totaled $2 million and less than $1 million for the three month ended June 30, 2019 and 2018, respectively, and $4 million and $1 million for the six month ended June 30, 2019 and 2018, respectively, and are included in other operating expenses in the accompanying condensed consolidated statements of loss.

Matters for which an Outcome Cannot be Assessed

For the following legal matter, due to the uncertainties surrounding the ultimate outcome of the case, 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.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

2011 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. In lieu of ruling on the Company’s motion to dismiss, the court permitted the plaintiffs to file a first amended consolidated class action complaint, which was filed on October 5, 2015. The Company’s motion to dismiss was filed on November 4, 2015 and oral argument was held on April 11, 2016. The Company’s motion to dismiss was granted on June 16, 2016 and on June 27, 2016, the plaintiffs filed a notice of appeal to the Sixth Circuit Court of Appeals. The matter was heard on May 3, 2017. On December 13, 2017, the Sixth Circuit reversed the trial court’s dismissal of the case and remanded it to the District Court. The Company filed a renewed partial motion to dismiss on February 9, 2018, which was denied by the District Court on September 24, 2018. The Company also filed a petition for a writ of certiorari to the United States Supreme Court on April 18, 2018 seeking review of the Sixth Circuit’s decision. The United States Supreme Court denied the petition for a writ of certiorari on October 1, 2018. The District Court granted the Plaintiff’s motion for class certification on July 26, 2019. The Company filed a petition for permission to appeal the District Court’s class certification order in the Sixth Circuit Court of Appeals on August 9, 2019, and that petition was denied on October 23, 2019. Trial for this matter was set for December 1, 2020. On January 21, 2020, the Company and the Plaintiff filed a stipulation of settlement indicating to the District Court that the parties had reached agreement on the principal terms of a settlement for $53 million, which was recorded by the Company during the three months ended December 31, 2019. The settlement received preliminary approval from the District Court on January 30, 2020. On June 22, 2020, the District Court granted final approval of the settlement and ordered the case dismissed with prejudice.

27


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

The table below presents a reconciliation of the beginning and ending liability balances (in millions) during the six months ended June 30, 2020, with respect to the Company’s determination of the contingencies of the Company in respect of which an accrual has been recorded.

Summary of Recorded Amounts

 

 

Probable

 

 

 

Contingencies

 

Balance as of December 31, 2019

 

$

68

 

Expense

 

 

10

 

Reserve for insured claim

 

 

10

 

Cash payments

 

 

(63

)

Balance as of June 30, 2020

 

$

25

 

In accordance with applicable accounting guidance, the Company establishes a liability for litigation, regulatory and governmental matters for which, based on information currently available, the Company believes that a negative outcome is known or is probable and the amount of the loss is reasonably estimable. For all such matters (whether or not discussed in this contingencies footnote), such amounts have been recorded in other accrued liabilities on the condensed consolidated balance sheet and are included in the table above. Due to the uncertainties and difficulty in predicting the ultimate resolution of these contingencies, the actual amount could differ from the estimated amount reflected as a liability on the condensed consolidated balance sheet.

In the aggregate, attorneys’ fees and other costs incurred but not included in the table above related to probable contingencies and Contingent Value Right-related contingencies totaled $2 million for the three months ended June 30, 2019, and $1 million and $4 million for the six months ended June 30, 2020 and 2019, respectively, and are included in other operating expenses in the accompanying condensed consolidated statements of income (loss). There was income of less than $1 million for the three months ended June 30, 2020 related to the above attorneys’ fees and other costs.

Matters for which an Outcome Cannot be Assessed

For the following legal matter, due to the uncertainties surrounding the ultimate outcome of the case, the Company cannot at this time assess what the outcome may be and is further unable to reasonably estimate any loss or range of loss.

Steadfast Insurance Company, et al v. Community Health Systems, Inc., CHS/Community Health Systems, Inc., CHSPSC, LLC and Pecos Valley of New Mexico, LLC; Community Health Systems, Inc., et al v. Steadfast Insurance Company, et al; Anne Sperling, et al v. Community Insurance Group SPC, Ltd. These cases are filed in the Superior Court for the State of Delaware, the Chancery Court for the State of Delaware, and the First Judicial District Court for the State of New Mexico, respectively, and involve insurance coverage disputes related to a $73 million judgment rendered against Pecos Valley of New Mexico, LLC in Anne Sperling, et al v. Pecos Valley of New Mexico, LLC (“Sperling I”). The first case was brought by Steadfast Insurance Company in Delaware Superior Court seeking a declaration that the Sperling I judgment is not a covered loss as defined by the insurance policies that are the subject of the case. The second case, filed by the Company in Delaware Chancery Court, seeks reformation of the subject policies. The third case (“Sperling II”), filed by the plaintiffs in Sperling I, seeks recovery from Pecos Valley of New Mexico, LLC’s insurers for the judgment awarded the plaintiffs in their separate, previous action against Pecos Valley of New Mexico, LLC. The Steadfast complaint was served on November 30, 2018. On December 13, 2018, Admiral Insurance Company, Endurance Specialty Insurance Ltd, and Illinois Union Insurance Company moved to intervene in the suit as petitioners. The Company has initiated counterclaims against each insurer in that case, including for bad faith against Steadfast. The Company filed the Community Health Systems complaint on January 22, 2020. Sperling II was filed on July 24, 2019.  Plaintiffs amended their complaint to add Pecos Valley of New Mexico, LLC as a defendant in that action on May 21, 2020, and Pecos Valley of New Mexico, LLC filed a third party action against certain insurer defendants in the case on July 6, 2020. The judgment in Sperling I against Pecos Valley of New Mexico, LLC, which was rendered on September 5, 2018, in the First Judicial Court of the State of New Mexico, is currently on appeal to the Court of Appeals of the State of New Mexico. Consolidated trial of the Steadfast and Community Health Systems, Inc. cases is set for July 26, 2021. The Company believes the insurers’ claims in the Steadfast, Community Health Systems, Inc. and Sperling II litigation are without merit and will vigorously defend this case.and prosecute those cases.

16.

28


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)

14.  SUBSEQUENT EVENTS

The Company has evaluated all material events occurring subsequent to the balance sheet date for events requiring disclosure or recognition in the condensed consolidated financial statements.

On AugustJuly 1, 2019,2020, one or more subsidiariesaffiliates of the Company sold Tennova Healthcare - Lebanon (245Northern Louisiana Medical Center (130 licensed beds) in Lebanon, Tennessee,Ruston, Louisiana and its associatedsubstantially all of the assets to a subsidiaryaffiliates of Vanderbilt University Medical CenterAllegiance Health Management, Inc. pursuant to the terms of a definitive agreement which was entered into on March 29, 2019.18, 2020, as referenced above. The net proceeds from this sale were received at a preliminary closing on June 30, 2020.

On AugustJuly 1, 2019,2020, one or more subsidiariesaffiliates of the Company sold College Stationthe majority ownership interest in St. Cloud Regional Medical Center (167(84 licensed beds) in College Station, Texas, and its associated assetsSt. Cloud, Florida to a subsidiaryaffiliates of St. Joseph RegionalOrlando Health, CenterInc., which held the minority ownership interest, pursuant to the terms of a definitive agreement which was entered into on May 23, 2019.April 27, 2020, as referenced above. The net proceeds from this sale were received at a preliminary closing on June 30, 2020.

On August 1, 2019, one or more subsidiaries of

In July 2020, the Company sold a 50% ownership interest in Merit Health Madison (67 licensed beds)received general and its associated healthcare businesses in Canton, Mississippi to HMC Madison, Inc., a Mississippi corporation owned bytargeted distributions totaling approximately $109 million from the Healthier Mississippi Collaborative,PHSSEF which is anon-profit company affiliated withdid not qualify for recognition during the University of Mississippi Medical Center, pursuant to the terms of a definitive agreement which was entered into on July 2, 2019.

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)three months ended June 30, 2020.

 

17.   SUPPLEMENTAL CONDENSED CONSOLIDATING15.  SUMMARIZED FINANCIAL INFORMATION

The 6⅞% Senior Notes due 2019, 2020 and 2022, which are senior unsecured obligations of CHS, the 518% Senior Secured Notes due 2021, and the 614% Senior Secured Notes due 2023, which are senior secured obligations of CHS (collectively, “the 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.subsidiaries (collectively, the “subsidiary guarantors”). In addition, equity interests held by the Company innon-guarantor subsidiaries have been pledged as collateral under the Notes, except for equity interests held in three3 hospitals owned jointly with anon-profit, health organization.organizations. The 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 consolidatingThere are no significant restrictions on the ability of the subsidiary guarantors to make distributions to the issuer. Summarized financial statements presentinformation is provided for Community Health Systems, Inc. (as parent(parent guarantor), CHS (as the issuer),(issuer) and the subsidiary guarantors the subsidiarynon-guarantors and eliminations. These condensed consolidating financial statements have been prepared and presentedon a combined basis in accordance with SECRegulation S-XRuleS-X Rules 3-10 “Financial Statements of Guarantors and Issuers of Guaranteed Securities Registered or Being Registered.”13-01.

The accounting policies used in the preparation of this summarized 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 fromthat intercompany transactions are presented in cash flows from financing activities, as changes in intercompanyand balances with affiliates, net.

Income tax expense is allocated fromof the parent, issuer and subsidiary guarantor to the income producing operations (other guarantors andnon-guarantors) and the issuer through stockholders’ deficit. As this approach represents an allocation, the income tax expense allocation is considerednon-cash for statement of cash flow purposes.

Interest expense, netentities with non-guarantors entities have not been eliminated. Equity in earnings from investments in non-guarantors entities has not 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 ABL Facility and Receivables Facility that are further discussed in Note 10. 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.presented.

From time to time, subsidiaries of the Company sell and/or repurchase noncontrolling interests in consolidated subsidiaries, which may change subsidiaries between guarantors andnon-guarantors. Amounts for prior periods have been revised to reflect the status of guarantors andnon-guarantors as of June 30, 2019.

2020.


29


COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS(UNAUDITED) (Continued)

 

Condensed Consolidating StatementSummarized statements of Loss

Three Months Ended June 30, 2019income (loss) (in millions):

 

                                                                                                                        
   Parent
  Guarantor  
       Issuer       Other
  Guarantors  
   Non -
  Guarantors  
    Eliminations     Consolidated  
   (In millions) 

Net operating revenues

  $-   $  $2,010   $1,291   $-   $3,302 

Operating costs and expenses:

            

Salaries and benefits

   -    -    766    722    -    1,488 

Supplies

   -    -    351    188    -    539 

Other operating expenses

   -    22    592    279   -    893 

Government and other legal settlements and related costs

   -    -       -    -    

Lease cost and rent

   -    -    43    38    -    81 

Depreciation and amortization

   -    -    93    60    -    153 

Impairment and (gain) loss on sale of businesses, net

   -    (2)    21    14    -    33 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating costs and expenses

   -    20   1,870    1,301    -    3,191 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

(Loss) income from operations

   -    (19)    140    (10)    -    111 

Interest expense, net

   -    157    127    (19)    -    265 

Equity in earnings of unconsolidated affiliates

   167    (7)    12    -    (177)    (5) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

(Loss) income before income taxes

   (167)    (169)          177    (149) 

(Benefit from) provision for income taxes

   -    (2)    (2)       -    (3) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net (loss) income

   (167)    (167)          177    (146) 

Less: Net income attributable to noncontrolling interests

   -    -    -    21    -    21 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net (loss) income attributable to Community Health Systems, Inc. stockholders

  $(167)   $(167)   $  $(13)   $177   $(167) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

Six Months Ended

 

 

June 30, 2020

 

Net operating revenues

$

3,672

 

Income from operations

 

532

 

Net income

 

168

 

Net income attributable to Community Health Systems, Inc. Stockholders

 

168

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIESSummarized balance sheets (in millions):

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

 

 

June 30,

2020

 

 

December 31,

2019

 

Current assets

 

$

3,596

 

 

$

2,464

 

Noncurrent assets (a)

 

 

14,495

 

 

 

14,596

 

Current liabilities

 

 

2,354

 

 

 

1,472

 

Noncurrent liabilities (b)

 

 

14,854

 

 

 

15,800

 

(a)

Includes amounts due from non-guarantor subsidiaries of $6.4 billion and $6.5 billion as of June 30, 2020 and December 31, 2019, respectively.

(b)

Includes amounts due to non-guarantor subsidiaries of $0.7 billion and $1.4 billion as of June 30, 2020 and December 31, 2019, respectively.

 

Condensed Consolidating Statement of Loss30

Three Months Ended June 30, 2018

                                                                                                                        
   Parent
  Guarantor  
       Issuer       Other
  Guarantors  
   Non -
  Guarantors  
    Eliminations     Consolidated  
   (In millions) 

Net operating revenues

  $-   $(2)   $2,182   $1,382   $-   $3,562 

Operating costs and expenses:

               

Salaries and benefits

   -    -    833    784    -    1,617 

Supplies

   -    -    388    204    -    592 

Other operating expenses

   -    -    577    302    -    879 

Government and other legal settlements and related costs

   -    -       -    -    

Lease cost and rent

   -    -    44    41    -    85 

Depreciation and amortization

   -    -    113    64    -    177 

Impairment and (gain) loss on sale of businesses, net

   -    14       156    -    174 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating costs and expenses

   -    14    1,960    1,551    -    3,525 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

(Loss) income from operations

   -    (16)    222    (169)    -    37 

Interest expense, net

   -    98    145    (8)    -    235 

(Gain) loss from early extinguishment of debt

   -    (65)       -    -    (64) 

Equity in earnings of unconsolidated affiliates

   110    116    192    -    (423)    (5) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Loss before income taxes

   (110)    (165)    (116)    (161)    423    (129) 

(Benefit from) provision for income taxes

   -    (55)       13    -    (38) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss

   (110)    (110)    (120)    (174)    423    (91) 

Less: Net income attributable to noncontrolling interests

   -    -    -    19    -    19 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss attributable to Community Health Systems, Inc. stockholders

  $(110)   $(110)   $(120)   $(193)   $423   $(110) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)


 

Condensed Consolidating Statement of Loss

Six Months Ended June 30, 2019

                                                                                                                        
   Parent
  Guarantor  
       Issuer       Other
  Guarantors  
   Non -
  Guarantors  
    Eliminations     Consolidated  
   (In millions) 

Net operating revenues

  $-   $44   $4,083   $2,552   $-   $6,679 

Operating costs and expenses:

                  

Salaries and benefits

   -    -    1,567    1,463    -    3,030 

Supplies

   -    -    724    373    -    1,097 

Other operating expenses

   -    22    1,122    560    -    1,704 

Government and other legal settlements and related costs

   -    -       -    -    

Lease cost and rent

   -    -    84    78    -    162 

Depreciation and amortization

   -    -    186    119    -    305 

Impairment and (gain) loss on sale of businesses, net

   -    (2)    45    28    -    71 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating costs and expenses

   -    20    3,737    2,621    -    6,378 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

   -    24    346    (69)    -    301 

Interest expense, net

   -    296    263    (37)    -    522 

Loss from early extinguishment of debt

   -    31    -    -    -    31 

Equity in earnings of unconsolidated affiliates

   285    (9)    90    -    (375)    (9) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Loss before income taxes

   (285)    (294)    (7)    (32)    375    (243) 

(Benefit from) provision for income taxes

   -    (9)    (4)    16    -    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss

   (285)    (285)    (3)    (48)    375    (246) 

Less: Net income attributable to noncontrolling interests

   -    -    -    39    -    39 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss attributable to Community Health Systems, Inc. stockholders

  $(285)   $(285)   $(3)   $(87)   $375   $(285) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Statement of Loss

Six Months Ended June 30, 2018

                                                                                                                        
   Parent
  Guarantor  
       Issuer       Other
  Guarantors  
   Non -
  Guarantors  
    Eliminations     Consolidated  
   (In millions) 

Net operating revenues

  $-   $(8)   $4,467   $2,792   $-   $7,251 

Operating costs and expenses:

            

Salaries and benefits

   -    -    1,680    1,585    -    3,265 

Supplies

   -    -    793    415    -    1,208 

Other operating expenses

   -    -    1,184    605    -    1,789 

Government and other legal settlements and related costs

   -    -       -    -    

Electronic health records incentive reimbursement

   -    -    -    (1)    -    (1) 

Lease cost and rent

   -    -    90    83    -    173 

Depreciation and amortization

   -    -    229    129    -    358 

Impairment and (gain) loss on sale of businesses, net

   -    14    20    168    -    202 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating costs and expenses

   -    14    4,003    2,984    -    7,001 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Loss from operations

   -    (22)    464    (192)    -    250 

Interest expense, net

   -    189    288    (13)    -    464 

(Gain) loss from early extinguishment of debt

   -    (61)       -    -    (59) 

Equity in earnings of unconsolidated affiliates

   135    82    214    -    (443)    (12) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Loss from income taxes

   (135)    (232)    (40)    (179)    443    (143) 

(Benefit from) provision for income taxes

   -    (97)    48       -    (45) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss

   (135)    (135)    (88)    (183)    443    (98) 

Less: Net income attributable to noncontrolling interests

   -    -    -    37    -    37 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net loss attributable to Community Health Systems, Inc. stockholders

  $(135)   $(135)   $(88)   $(220)   $443   $(135) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Statement of Comprehensive Loss

Three Months Ended June 30, 2019

                                                                                                                        
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 

Net (loss) income

  $(167)   $(167)   $  $  $177   $(146) 

Other comprehensive income (loss), net of income taxes:

            

Net change in fair value of interest rate swaps, net of tax

   -    -    -    -    -    - 

Net change in fair value ofavailable-for-sale securities, net of tax

            -    (4)    

Amortization and recognition of unrecognized pension cost components, net of tax

   -    -    -    -    -    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income (loss)

            -    (4)    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive (loss) income

   (165)    (165)          173    (144) 

Less: Comprehensive income attributable to noncontrolling interests

   -    -    -    21    -    21 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders

  $(165)   $(165)   $  $(13)   $173   $(165) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Condensed Consolidating Statement of Comprehensive Loss

Three Months Ended June 30, 2018

                                                                                                                        
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 

Net loss

  $(110)   $(110)   $(120)   $(174)   $423   $(91) 

Other comprehensive income (loss), net of income taxes:

            

Net change in fair value of interest rate swaps, net of tax

         -    -    (7)    

Net change in fair value ofavailable-for-sale securities, net of tax

   (1)    (1)    (1)    -       (1) 

Amortization and recognition of unrecognized pension cost components, net of tax

            -    (2)    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income

         -    -    (7)    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss

   (103)    (103)    (120)    (174)    416    (84) 

Less: Comprehensive income attributable to noncontrolling interests

   -    -    -    19    -    19 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss attributable to Community Health Systems, Inc. stockholders

  $(103)   $(103)   $(120)   $(193)   $416   $(103) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Statement of Comprehensive Loss

Six Months Ended June 30, 2019

                                                                                                                        
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 

Net loss

  $(285)   $(285)   $(3)   $(48)   $375   $(246) 

Other comprehensive (loss) income, net of income taxes:

            

Net change in fair value of interest rate swaps, net of tax

   (2)    (2)    -    -       (2) 

Net change in fair value ofavailable-for-sale securities, net of tax

            -    (8)    

Amortization and recognition of unrecognized pension cost components, net of tax

   -    -    -    -    -    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income

            -    (6)    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive (loss) income

   (283)    (283)       (48)    369    (244) 

Less: Comprehensive income attributable to noncontrolling interests

   -    -    -    39    -    39 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders

  $(283)   $(283)   $  $(87)   $369   $(283) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Condensed Consolidating Statement of Comprehensive Loss

Six Months Ended June 30, 2018

                                                                                                                        
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 

Net loss

  $(135)   $(135)   $(88)   $(183)   $443   $(98) 

Other comprehensive income (loss), net of income taxes:

            

Net change in fair value of interest rate swaps, net of tax

   25    25    -    -    (25)    25 

Net change in fair value ofavailable-for-sale securities, net of tax

   (2)    (2)    (2)    -       (2) 

Amortization and recognition of unrecognized pension cost components, net of tax

            -    (2)    
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income (loss)

   24    24    (1)    -    (23)    24 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss

   (111)    (111)    (89)    (183)    420    (74) 

Less: Comprehensive income attributable to noncontrolling interests

   -    -    -    37    -    37 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive loss attributable to Community Health Systems, Inc. stockholders

  $(111)   $(111)   $(89)   $(220)   $420   $(111) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Balance Sheet

June 30, 2019

                                                                                                                                                
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 
   ASSETS       

Current assets:

            

Cash and cash equivalents

    $-     $-     $163     $44     $-     $207 

Patient accounts receivable

   -    -    1,949    407    -    2,356 

Supplies

   -    -    241    137    -    378 

Prepaid income taxes

   -    -    -    -    -    - 

Prepaid expenses and taxes

   -    -    128    49    -    177 

Other current assets

   -    -    112    254    -    366 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total current assets

   -    -    2,593    891    -    3,484 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany receivable

   -    12,552    4,791    6,161    (23,504)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Property and equipment, net

   -    -    3,802    2,132    -    5,934 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Goodwill

   -    -    2,692    1,802    -    4,494 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deferred income taxes

   57    -    -    -    -    57 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other assets, net

   -    -    1,255    908    -    2,163 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net investment in subsidiaries

   -    22,182    11,867    -    (34,049)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total assets

    $57     $34,734     $27,000     $11,894     $(57,553)     $16,132 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
   LIABILITIES AND DEFICIT       

Current liabilities:

            

Current maturities of long-term debt

    $-     $155     $26     $25     $-     $206 

Current operating lease liabilities

   -    -    72    61    -    133 

Accounts payable

   -    -    507    305    -    812 

Accrued interest

   -    388    -    -    -    388 

Accrued liabilities

   -       522    441    -    964 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total current liabilities

   -    544    1,127    832    -    2,503 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Long-term debt

   -    13,173    144    76    -    13,393 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany payable

   1,863    22,762    24,639    11,759    (61,023)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deferred income taxes

   26    -    -    -    -    26 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Long-term operating lease liabilities

   -    -    234    245    -    479 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other long-term liabilities

         720    263    -    987 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total liabilities

   1,890    36,482    26,864    13,175    (61,023)    17,388 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Redeemable noncontrolling interests in equity of consolidated subsidiaries

   -    -    -    503    -    503 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deficit:

            

Community Health Systems, Inc. stockholders’ deficit:

            

Common stock

      -    -    -    -    

Additionalpaid-in capital

   2,002    (393)    161   (586)    818    2,002 

Accumulated other comprehensive loss

   (8)    (8)    (10)    -    18    (8) 

(Accumulated deficit) retained earnings

   (3,828)    (1,347)    (15)    (1,272)    2,634    (3,828) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Community Health Systems, Inc. stockholders’ (deficit) equity

   (1,833)    (1,748)    136    (1,858)    3,470    (1,833) 

Noncontrolling interests in equity of consolidated subsidiaries

   -    -    -    74    -    74 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total (deficit) equity

   (1,833)    (1,748)    136    (1,784)    3,470    (1,759) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total liabilities and deficit

    $57     $34,734     $27,000     $11,894     $(57,553)     $16,132 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Balance Sheet

December 31, 2018

                                                                                                                                                
   Parent
Guarantor
   Issuer   Other
Guarantors
   Non -
Guarantors
   Eliminations   Consolidated 
   (In millions) 
   ASSETS       

Current assets:

            

Cash and cash equivalents

    $-     $-     $135     $61     $-     $196 

Patient accounts receivable

   -    -    1,974    378    -    2,352 

Supplies

   -    -    262    140    -    402 

Prepaid income taxes

      -    -    -    -    

Prepaid expenses and taxes

   -    -    132    64    -    196 

Other current assets

   -    -    132    268    -    400 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total current assets

      -    2,635    911    -    3,549 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany receivable

   -    12,696    4,895    6,314    (23,905)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Property and equipment, net

   -    -    3,994    2,145    -    6,139 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Goodwill

   -    -    2,760    1,799    -    4,559 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deferred income taxes

   69    -    -    -    -    69 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other assets, net

   -    25    958    560    -    1,543 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net investment in subsidiaries

   -    21,642    11,617    -    (33,259)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total assets

    $72     $34,363     $26,859     $11,729     $(57,164)     $15,859 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
   LIABILITIES AND DEFICIT       

Current liabilities:

            

Current maturities of long-term debt

    $-     $155     $22     $27     $-     $204 

Accounts payable

   -    -    595    292    -    887 

Accrued interest

   -    206    -    -    -    206 

Accrued liabilities

   -    -    638    457    -    1,095 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total current liabilities

   -    361    1,255    776    -    2,392 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Long-term debt

   -    13,167    147    78    -    13,392 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany payable

   1,572    22,299    24,599    11,796    (60,266)    - 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deferred income taxes

   26    -    -    -    -    26 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Other long-term liabilities

         714    283    -    1,008 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total liabilities

   1,607    35,829    26,715    12,933    (60,266)    16,818 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Redeemable noncontrolling interests in equity of consolidated subsidiaries

   -    -    -    504    -    504 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Deficit:

            

Community Health Systems, Inc. stockholders’ deficit:

            

Common stock

      -    -    -    -    

Additionalpaid-in capital

   2,017    (329)    162   (565)    732    2,017 

Accumulated other comprehensive loss

   (10)    (10)    (5)    (9)    24    (10) 

(Accumulated deficit) retained earnings

   (3,543)    (1,127)    (13)    (1,206)    2,346    (3,543) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Community Health Systems, Inc. stockholders’ (deficit) equity

   (1,535)    (1,466)    144    (1,780)    3,102    (1,535) 

Noncontrolling interests in equity of consolidated subsidiaries

   -    -    -    72    -    72 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total (deficit) equity

   (1,535)    (1,466)    144    (1,708)    3,102    (1,463) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total liabilities and deficit

    $72     $34,363     $26,859     $11,729     $(57,164)     $15,859 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Statement of Cash Flows

Six Months Ended June 30, 2019

                                                                                                                                                
   Parent       Other   Non -         
   Guarantor   Issuer   Guarantors   Guarantors   Eliminations   Consolidated 
   (In millions) 

Net cash provided by (used in) operating activities

    $4    $(67)     $210     $118     $-     $265 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

            

Acquisitions of facilities and other related businesses

   -    -    (6)    (7)    -    (13) 

Purchases of property and equipment

   -    -    (176)    (36)    -    (212) 

Proceeds from disposition of hospitals and other ancillary operations

   -    18    135       -    161 

Proceeds from sale of property and equipment

   -    -    -       -    

Purchases ofavailable-for-sale securities and equity securities

   -    -    (15)    (24)    -    (39) 

Proceeds from sales ofavailable-for-sale securities and equity securities

   -    -    25    27    -    52 

Increase in other investments

   -    -    (63)    (34)    -    (97) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) investing activities

   -    18    (100)    (65)    -    (147) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

            

Repurchase of restricted stock shares for payroll tax withholding requirements

   (1)    -    -    -    -    (1) 

Deferred financing costs and other debt-related costs

   -    (28)    -    -    -    (28) 

Proceeds from noncontrolling investors in joint ventures

   -    -    -       -    

Redemption of noncontrolling investments in joint ventures

   -    -    -    (2)    -    (2) 

Distributions to noncontrolling investors in joint ventures

   -    -    -    (57)    -    (57) 

Changes in intercompany balances with affiliates, net

   (3)    94    (82)    (9)    -    - 

Borrowings under credit agreements

   -    -    23    -    -    23 

Issuance of long-term debt

   -    2,034    -    -    -    2,034 

Proceeds from ABL facility

   -    25    -    -    -    25 

Repayments of long-term indebtedness

   -    (2,076)    (23)    (4)    -    (2,103) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

   (4)    49    (82)    (70)    -    (107) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net change in cash and cash equivalents

   -    -    28    (17)    -    11 

Cash and cash equivalents at beginning of period

   -    -    135    61    -    196 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

    $-     $-     $163     $44     $-     $207 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – (Continued)

Condensed Consolidating Statement of Cash Flows

Six Months Ended June 30, 2018

                                                                                                                                                
   Parent       Other   Non -         
   Guarantor   Issuer   Guarantors   Guarantors   Eliminations   Consolidated 
   (In millions) 

Net cash provided by (used in) operating activities

    $37     $(228)     $94     $191     $-     $94 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

            

Acquisitions of facilities and other related businesses

   -    -    (3)    (7)    -    (10) 

Purchases of property and equipment

   -    -    (213)    (82)    -    (295) 

Proceeds from disposition of hospitals and other ancillary operations

   -    -    12    76    -    88 

Proceeds from sale of property and equipment

   -    -          -    

Purchases ofavailable-for-sale securities and equity securities

   -    -    (25)    (13)    -    (38) 

Proceeds from sales ofavailable-for-sale securities and equity securities

   -    -    50    13    -    63 

Increase in other investments

   -    -    (24)    (29)    -    (53) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

   -    -    (202)    (39)    -    (241) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

            

Repurchase of restricted stock shares for payroll tax withholding requirements

   (1)    -    -    -    -    (1) 

Deferred financing costs and other debt-related costs

   -    (54)    -    -    -    (54) 

Proceeds from noncontrolling investors in joint ventures

   -    -    -       -    

Redemption of noncontrolling investments in joint ventures

   -    -    -    (6)    -    (6) 

Distributions to noncontrolling investors in joint ventures

   -    -    -    (52)    -    (52) 

Changes in intercompany balances with affiliates, net

   (36)    (186)    315    (93)    -    - 

Borrowings under credit agreements

   -    -    22       -    26 

Issuance of long-term debt

   -    -    -    -    -    - 

Proceeds from ABL facility

   -    538    49    -    -    587 

Repayments of long-term indebtedness

   -    (70)    (636)    (3)    -    (709) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

   (37)    228    (250)    (149)    -    (208) 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net change in cash and cash equivalents

   -    -    (358)       -    (355) 

Cash and cash equivalents at beginning of period

   -    -    471    92    -    563 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

    $-     $-     $113     $95     $-     $208 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Item 2.ManagementsManagement’s Discussion and Analysis of Financial Condition and Results of Operations

You should read this discussion together with our condensed consolidated financial statements and the accompanying notes included herein.

Throughout this Quarterly Report on Form10-Q, we refer to Community Health Systems, Inc., or the Parent Company, and its consolidated subsidiaries in a simplified manner and on a collective basis, using words like “we,” “our,” “us” and the “Company”. This drafting style is suggested by the Securities and Exchange Commission, or SEC, and is not meant to indicate that the publicly traded Parent Company or any particular 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 by distinct and indirect subsidiaries of Community Health Systems, Inc.

Executive Overview

We are one of the largest publicly traded hospital companies in the United States and a leading operator of general acute care hospitals and outpatient facilities in communities across the country. We provide healthcare services through the hospitals that we own and operate and affiliated businesses innon-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 outpatient services to patients in the communities in which we are located. As of June 30, 2019,2020, we owned or leased 10797 hospitals, comprised of 10595 general acute care hospitals and two stand-alone rehabilitation or psychiatric hospitals. For the hospitals that we own and operate, we are paid for our services by governmental agencies, private insurers and directly by the patients we serve.

We have been implementing a portfolio rationalization and deleveraging strategy by divesting hospitals andnon-hospital businesses that are attractive to strategic and other buyers. Generally, these businessesAs discussed further below, we currently expect planned divestitures to be completed during the third and fourth quarters of 2020.

COVID-19 Pandemic

A novel strain of coronavirus causing the disease known as COVID-19 was first identified in Wuhan, China in December 2019, and has spread throughout the world, including across the United States. In January 2020, the Secretary of the U.S. Department of Health and Human Services, or HHS, declared a national public health emergency due to the novel coronavirus. In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In an attempt to contain the spread and impact of COVID-19, authorities throughout the United States and the world have implemented measures such as travel bans and restrictions, quarantines, stay-at-home and shelter-in-place orders, the promotion of social distancing, and limitations on business activity. This pandemic has resulted in a significant economic downturn in the United States and globally and has also led to significant disruptions and volatility in capital and financial markets.

As a provider of healthcare services, we are significantly exposed to the public health and economic effects of the COVID-19 pandemic. The safety of our patients, physicians, nurses, and employees in the communities in which we serve remains our primary focus. We have been working with federal, state and local health authorities to respond to the COVID-19 pandemic cases in the communities we serve and have been taking or supporting measures to try to limit the spread of the virus and to mitigate the burden on the healthcare system, including rescheduling or cancelling elective procedures at our hospitals and other healthcare facilities. In addition, some states have been requiring hospitals to maintain a reserve of personal protective equipment and mandating COVID-19 screening for new patients and certain hospital staff.

Beginning in March 2020, we experienced a substantial reduction in the number of elective surgeries, physician office visits and emergency room volumes at our hospitals and other healthcare facilities due to restrictions on elective procedures, quarantines, stay-at-home and shelter-in-place orders, the promotion of social distancing, as well as general concerns related to the risk of contracting COVID-19 from interacting with the healthcare system. A general easing of restrictive measures beginning in May and June 2020 resulted in greater volume during such periods in comparison to April 2020 levels, although patient volume in May and June 2020 remained below pre-COVID-19 levels. Some restrictive measures remain in place and, as of the time of this filing, some states and local governments are re-imposing restrictions due to increasing rates of COVID-19 cases, including in select markets that we serve, which may continue to adversely impact our operating results. In addition, some individuals may choose to postpone medical care for an undetermined period of time, even in the absence of government or industry-adopted restrictions. Given the general necessity of the healthcare services we provide, we anticipate that in the future historically normal service levels may resume and that the deferral of services during the pandemic may create a backlog of demand; however, there is no assurance that either will occur and, to the extent this occurs, when this will occur.

31


Our hospitals, medical clinics, medical personnel, and employees have been actively caring for COVID-19 patients. Although we have been implementing considerable safety measures, treatment of COVID-19 patients has associated risks, which may include the manner in which medical personnel perceive and respond to such risks. While our hospitals have not experienced major capacity constraints to date arising from the treatment of COVID-19 patients, there are hospitals in the United States that are located in centers of the COVID-19 outbreak and have been overwhelmed in caring for COVID-19 patients, which has prevented such hospitals from treating all patients who seek care. Our hospitals could be subject to such conditions in the future if a major COVID-19 outbreak occurs in a geographic region where any of our hospitals are located. In addition, some states have been limiting hospital volume by requiring a minimum percentage of vacant beds in case of a surge in COVID-19 patients.

We may experience supply chain disruptions as the result of the COVID-19 pandemic, including delays and price increases in equipment, pharmaceuticals and medical supplies. Staffing, equipment, and pharmaceutical and medical supplies shortages may impact our ability to admit and treat patients. We have incurred, and may continue to incur, certain increased expenses arising from the COVID-19 pandemic, including additional supply chain and other expenditures.

Broad economic factors resulting from the COVID-19 pandemic, including high unemployment and underemployment levels and reduced consumer spending and confidence, may also affect our service mix, revenue mix, payor mix and patient volumes, as well as our ability to collect outstanding receivables. Business closures and layoffs in the geographic areas in which we operate has led to increases in the uninsured and underinsured populations, which may continue to adversely affect demand for our services, as well as the ability of patients and other payors to pay for services rendered. A material increase in the amount or deterioration in the collectability of patient accounts receivable may adversely affect our financial results and require an increased level of working capital.

We are not able to fully quantify the impact that the COVID-19 pandemic will have on our financial results during 2020, but expect developments related to COVID-19 to materially affect our financial performance in one2020. Moreover, the COVID-19 pandemic may otherwise have material adverse effects on our results of our strategically beneficial service areas, are less complementary to our business strategyoperations, financial position, and/or have lower operating margins. In connection with our announced divestiture initiative,cash flows,particularly if negative economic and/or public health conditions in the United States continue to deteriorate or persist for a significant period of time. The ultimate impact of the pandemic on our financial results will depend on, among other factors, the duration and severity of the pandemic as well as negative economic conditions arising from the pandemic, the volume of canceled or rescheduled procedures at our facilities, the volume of COVID-19 patients cared for across our health systems, the timing and availability of effective medical treatments and vaccines, and the impact of government actions and administrative regulations on the hospital industry and broader economy, including through existing and any future stimulus efforts. Furthermore, the pandemic has resulted in, and may continue to result in, significant disruption of global financial markets, which could reduce our ability to access capital and negatively affect our liquidity in the future. As discussed below under “Legislative Overview”, we have received, offersand may continue to receive, payments and advances under the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, and the Paycheck Protection Program and Health Care Enhancement Act, or PPPHCE Act, which have been beneficial in partially mitigating impact of the COVID-19 pandemic on our results of operations and financial position to date. Additionally, the federal government may consider additional stimulus and relief efforts, but we are unable to predict whether any additional stimulus measures will be enacted or their impact, if any. We are unable to assess the extent to which anticipated negative impacts on us arising from strategic buyers to buy certain of our assets. After considering these offers,the COVID-19 pandemic will ultimately be offset by amounts received, and which we have divestedmay in the future receive, under the CARES Act, the PPPHCE Act, or may divest hospitals andnon-hospital businesses when we find such offers to be attractive and in line with our operating strategy.any future federal stimulus measures.

Completed Divestiture and Acquisition Activity

During the six months ended June 30, 2020, we completed the divestiture of five hospitals, including three which closed effective January 1, 2020 (for these hospitals, we received the net proceeds at a preliminary closing on December 31, 2019). These five hospitals represented annual net operating revenues in 2019 of approximately $350 million and, including the net proceeds for the three hospitals that preliminarily closed on December 31, 2019, we received total net proceeds of approximately $256 million in connection with the disposition of these hospitals. In addition, we completed the divestiture of an additional two hospitals on July 1, 2020 for which we received net proceeds of approximately $133 million at a preliminary closing held on June 30, 2020.

During 2019, we completed the divestiture of seven12 hospitals, including two hospitals the divestitures of which closed effective January 1, 2019 (for these hospitals, we received the net proceeds at a preliminary closing on December 31, 2018)., but not including the three hospitals noted which closed on January 1, 2020. These seven12 hospitals represented annual net operating revenues in 2018 of approximately $620 million$1.1 billion and, excluding the net proceeds for the two hospitals that preliminarily closed on December 31, 2018, we received total net proceeds of approximately $161$335 million in connection with the disposition of these hospitals.

During 2018, we completed the divestiture of 11 hospitals. These 11 hospitals represented annual net operating revenues in 2017 of approximately $950 million and, including the net proceeds for the two additional hospitals that preliminarily closed on December 31, 2018 noted above, we received total net proceeds of approximately $405 million in connection with the disposition of these hospitals.32


The following table provides a summary of hospitals that we divested during the six months ended June 30, 20192020 and the year ended December 31, 2018:2019:

 

Licensed

Hospital

Buyer

City, State

Licensed

Beds

Effective Date

2020 Divestitures:

2019 Divestitures:

Shands Live Oak Regional Medical Center

HCA Healthcare, Inc., or HCA,

Live Oak, FL

25

May 1, 2020

Shands Starke Regional Medical Center

HCA

Starke, FL

49

May 1, 2020

Southside Regional Medical Center

Bon Secours Mercy Health System

Petersburg, VA

300

January 1, 2020

Southampton Memorial Hospital

Bon Secours Mercy Health System

Franklin, VA

105

January 1, 2020

Southern Virginia Regional Medical Center

Bon Secours Mercy Health System

Emporia, VA

80

January 1, 2020

2019 Divestitures:

Bluefield Regional Medical Center

Princeton Community Hospital Association

Bluefield, WV

92

October 1, 2019

Lake Wales Medical Center

Adventist Health System

Lake Wales, FL

160

September 1, 2019

Heart of Florida Regional Medical Center

Adventist Health System

Davenport, FL

193

September 1, 2019

College Station Medical Center

St. Joseph Regional Health Center

College Station, TX

167

August 1, 2019

Tennova Healthcare - Lebanon

Vanderbilt University Medical Center

Lebanon, TN

245

August 1, 2019

Chester Regional Medical Center

Medical University Hospital Authority

Chester, SC

82

82

March 1, 2019

Carolinas Hospital System - Florence

Medical University Hospital Authority

Florence, SC

396

396

March 1, 2019

Springs Memorial Hospital

Medical University Hospital Authority

Lancaster, SC

225

225

March 1, 2019

Carolinas Hospital System - Marion

Medical University Hospital Authority

Mullins, SC

124

124

March 1, 2019

Memorial Hospital of Salem County

Community Healthcare Associates, LLC

Salem, NJ

126

126

January 31, 2019

Mary Black Health System - Spartanburg

Spartanburg Regional Healthcare System

Spartanburg, SC

207

207

January 1, 2019

Mary Black Health System - Gaffney

Spartanburg Regional Healthcare System

Gaffney, SC

125

125

January 1, 2019

2018 Divestitures:

Sparks Regional Medical Center

Baptist HealthFort Smith, AR492November 1, 2018

Sparks Medical Center - Van Buren

Baptist HealthVan Buren, AR103November 1, 2018

AllianceHealth Deaconess

INTEGRIS HealthOklahoma City, OK238October 1, 2018

Munroe Regional Medical Center

Adventist Health SystemOcala, FL425August 1, 2018

Tennova Healthcare - Dyersburg Regional

West Tennessee HealthcareDyersburg, TN225June 1, 2018

Tennova Healthcare - Regional Jackson

West Tennessee HealthcareJackson, TN150June 1, 2018

Tennova Healthcare - Volunteer Martin

West Tennessee HealthcareMartin, TN100June 1, 2018

Williamson Memorial Hospital

Mingo Health Partners, LLCWilliamson, WV76June 1, 2018

Byrd Regional Hospital

Allegiance Health ManagementLeesville, LA60June 1, 2018

Tennova Healthcare - Jamestown

Rennova Health, Inc.Jamestown, TN85June 1, 2018

Bayfront Health Dade City

Adventist Health SystemDade City, FL120April 1, 2018

On May 22, 2019,

In addition, on July 1, 2020, we signed a definitive agreement forcompleted the sale of Lake WalesNorthern Louisiana Medical Center (160(130 licensed beds) in Lake Wales, Florida,Ruston, Louisiana and Heartsubstantially all of Florida Regional Medical Center (193 licensed beds) in Davenport, Florida, and their associatedthe assets to a subsidiaryaffiliates of AdventistAllegiance Health System Sunbelt Healthcare Corporation.

On June 27, 2019, we signed a definitive agreement for the sale of Bluefield Regional Medical Center (92 licensed beds) in Bluefield, West Virginia, and its associated assets to a subsidiary of Princeton Community Hospital Association.

On August 1, 2019, we sold Tennova Healthcare - Lebanon (245 licensed beds) in Lebanon, Tennessee, and its associated assets to a subsidiary of Vanderbilt University Medical CenterManagement, Inc. pursuant to the terms of a definitive agreement which was entered into on March 29, 2019.18, 2020. The net proceeds from this sale were received at a preliminary closing on June 30, 2020.

On AugustJuly 1, 2019,2020, we sold College Stationcompleted the sale of the majority ownership interest in St. Cloud Regional Medical Center (167(84 licensed beds) in College Station, Texas, and its associated assetsSt. Cloud, Florida to a subsidiaryaffiliates of St. Joseph RegionalOrlando Health, CenterInc., which held the minority ownership interest, pursuant to the terms of a definitive agreement which was entered into on May 23, 2019.April 27, 2020. The net proceeds from this sale were received at a preliminary closing on June 30, 2020.

On August 1, 2019, we sold a 50% ownership interest in Merit Health Madison (67 licensed beds) and its associated healthcare businesses in Canton, Mississippi to HMC Madison, Inc., a Mississippi corporation owned by the Healthier Mississippi Collaborative, which is anon-profit company affiliated with the University of Mississippi Medical Center, pursuant to the terms of a definitive agreement which was entered into on July 2, 2019.

In addition to the divestiture of thesethe hospitals in 20182019 and 2019 as2020 noted above, we continuehave entered into definitive agreements to sell a total of five hospitals, for which we expect to receive interest from potential buyers for certainaggregate proceeds of approximately $430 million.

On April 20, 2020, we entered into a definitive agreement for the sale of substantially all of the assets of San Angelo Community Medical Center (171 licensed beds) in San Angelo, Texas to affiliates of Shannon Health System.

On April 27, 2020, we entered into a definitive agreement for the sale of substantially all of the assets of each of Abilene Regional Medical Center (231 licensed beds) in Abilene, Texas and Brownwood Regional Medical Center (188 licensed beds) in Brownwood, Texas to subsidiaries of Hendrick Health System.

33


On May 28, 2020, we entered into a definitive agreement for the sale of our ownership interest in Hill Regional Hospital (25 licensed beds) in Hillsboro, Texas to AHRK Holdings, LLC.

On June 25, 2020, we entered into a definitive agreement for the sale of substantially all the assets of Bayfront Health St. Petersburg (480 licensed beds) in St. Petersburg, Florida to affiliates of Orlando Health, Inc.

These divestitures subject to definitive agreements, which are expected to be completed at various times during the third and fourth quarters of 2020, will mark the end of our hospitals. We intend to continue ourformal portfolio rationalization strategy, during the remainder of 2019 and are pursuing additional interests for sale transactions, which are currentlycommenced in various stages of negotiation with potential buyers.2017. There can be no assurance that these potential divestitures (or the potential divestitures currently subject to definitive agreements)agreements will be

completed, or if they are completed, the ultimate timing of the completion of these divestitures. We continue to receive interest from potential acquirers for certain of our hospitals, and may, from time to time, consider selling additional hospitals following the completion of our formal portfolio rationalization strategy, if we consider any such disposition to be in our best interests.

Weexpect to use proceeds from divestitures to reduce debt and/or reinvest in our facilities to strengthen our regional networks and local market operations.

On June 1, 2019, we completed the acquisition of Northwest Mississippi Medical Center in Clarksdale, Mississippi. This healthcare system includes 181 licensed beds and other outpatient and ancillary services. The total cash consideration paid for operating assets was approximately $2 million, with additional consideration of $5 million in assumed liabilities, for a total consideration of $7 million. This hospital was acquired in conjunction with the bankruptcy proceedings of the previous owner that acquired the hospital from the Company in 2017 as part of an agreement with the local county government associated with its lease of the hospital building. Based on the current purchase price allocation relating to this acquisition, no goodwill has been recorded. Prior to the completion of the acquisition, the Company initiated a plan to sell this hospital and as such has classified this hospital as held for sale at June 30, 2019.general corporate purposes.

During the six months ended June 30, 2019,2020, we paid approximately $7less than $1 million to acquire the operating assets and related businesses of certain physician practices, clinics and other ancillary businesses that operate within the communities served by our hospitals.

During the three months ended June 30, 2020, we entered into a settlement and termination agreement with the Lake Shore Hospital Authority for the planned closure of the Shands Lake Shore Regional Medical Center in Lake City, Florida. The closure is currently expected to be completed by August 31, 2020. An immaterial adjustment was recorded during the three months ended June 30, 2020 to adjust the supplies, inventory and long-lived assets to fair value.

Overview of Operating Results

Our net operating revenues for the three months ended June 30, 20192020 decreased $260$783 million to approximately $3.3$2.5 billion compared to approximately $3.6$3.3 billion for the three months ended June 30, 2018.2019, primarily as a result of developments related to COVID-19 as highlighted above, and hospitals divested during 2019 and 2020. On a same-store basis, net operating revenues for the three months ended June 30, 2019 increased $1532020 decreased $571 million, compared toalso primarily as a result of the three months ended June 30, 2018.COVID-19 pandemic.

We had a net lossincome of $146$93 million during the three months ended June 30, 2019,2020, compared to a net loss of $91$146 million for the three months ended June 30, 2018. Loss2019. Net income for the three months ended June 30, 2020 included the following:

an after-tax charge of $2 million for government and other legal settlements and related costs,

an after-tax charge of $22 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values, and

an after-tax charge of $4 million for employee termination benefits and other restructuring costs.

Net loss for the three months ended June 30, 2019 included the following:

an after-tax charge of $3 million for government and other legal settlements, net of related legal expenses,

an after-tax charge of $1 million for employee termination benefits and other restructuring costs,

an after-tax charge of $17 million to reserve the outstanding balance of a promissory note that was received as part of the purchase price from the sale of two hospitals in 2017 following such time that the buyer in such acquisition, which was the maker of the note filed for bankruptcy during the second quarter,

an after-tax charge of $53 million for a change in estimate for professional liability claims accrual related to claims incurred in 2016 and prior years,

an after-tax charge of $37million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values, and

an after-tax charge of $2 million for legal expenses related to the settlement of certain Health Management Associates, Inc., or HMA, legal proceedings entered into with the U.S. Department of Justice during the three months ended September 30, 2018, or the HMA Legal Matters.

34


 

anafter-tax charge of $3 million for government and other legal settlements, net of related legal expenses,

anafter-tax charge of $1 million for employee termination benefits and other restructuring costs,

anafter-tax charge of $17 million to reserve the outstanding balance of a promissory note that was received as part of the purchase price from the sale of two hospitals in 2017 following such time that the buyer in such acquisition, which was the maker of the note filed for bankruptcy during the second quarter,

anafter-tax charge of $53 million for a change in estimate for professional liability claims accrual related to claims incurred in 2016 and prior years,

anafter-tax charge of $37 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values, and

anafter-tax charge of $2 million for legal expenses related to the settlement of the CVR agreement liability and related HMA legal proceedings.

Loss for the three months ended June 30, 2018 included the following:

anafter-tax charge of $1 million for government and other legal settlements, net of related legal expenses,

anafter-tax charge of $145 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values,

anafter-tax charge of $9 million for employee termination benefits and other restructuring costs,

after-tax income of $50 million for gain from early extinguishment of debt, and

anafter-tax charge of $3 million from fair value adjustments on the CVR agreement liability accounted for at fair value related to the Health Management Associates, Inc., or HMA, legal proceedings, and related legal expenses.

Consolidated inpatient admissions for the three months ended June 30, 2019,2020, decreased 11.5%23.6%, compared to the three months ended June 30, 2018.2019. Consolidated adjusted admissions for the three months ended June 30, 2019,2020, decreased 12.3%29.2%, compared to the three months ended June 30, 2018.2019. Same-store inpatient admissions for the three months ended June 30, 2019, increased 2.3%2020, decreased 18.1%, compared to the three months ended June 30, 2018,2019, and same-store adjusted admissions for the three months ended June 30, 2019, increased 1.8%2020, decreased 24.2%, compared to the three months ended June 30, 2018.2019. These same-store decreases primarily resulted from the impact of the COVID-19 pandemic.

Our net operating revenues for the six months ended June 30, 20192020 decreased $572 million$1.1 billion to approximately $6.7$5.5 billion compared to approximately $7.3$6.7 billion for the six months ended June 30, 2018.2019, primarily as a result of developments related to COVID-19 as highlighted above, and hospitals divested during 2019 and 2020. On a same-store basis, net operating revenues for the six months ended June 30, 2019 increased $2532020 decreased $679 million, compared toalso primarily as a result of the six months ended June 30, 2018.COVID-19 pandemic.

We had a net lossincome of $246$126 million during the six months ended June 30, 2019,2020, compared to a net loss of $98$246 million for the six months ended June 30, 2018. Loss2019. Net income for the six months ended June 30, 2020 included the following:

an after-tax charge of $3 million for government and other legal settlements and related costs,

an after-tax charge of $3 million for loss from early extinguishment of debt,

an after-tax charge of $57 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values,

an after-tax charge of $4 million for employee termination benefits and other restructuring costs,

an after-tax charge of $1 million for legal expenses related to the settlement of the HMA Legal Matters, and

income of approximately $240 million due to discrete tax benefits related to the release of federal and state valuation allowances on IRC Section 163(j) interest carryforwards as a result of an increase to the deductible interest expense allowed for 2019 and 2020 under the CARES Act that was enacted during the six months ended June 30, 2020.

Net loss for the six months ended June 30, 2019 included the following:

an

an after-tax charge of $7 million for government and other legal settlements, net of related legal expenses,

an

an after-tax charge of $66 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values,

an

an after-tax charge of $1 million for employee termination benefits and other restructuring costs,

an

an after-tax charge of $17 million to reserve the outstanding balance of a promissory note outstanding that was received as part of the purchase price from the sale of two hospitals in 2017 following such time that the buyer in such acquisition, which was the maker of the note filed for bankruptcy during the second quarter,

an

an after-tax charge of $53 million for a change in estimate for professional liability claims accrual related to claims incurred in 2016 and prior years,

an

an after-tax charge of $23 million for loss from early extinguishment of debt, and

anafter-tax charge of $3 million from legal expenses related to the settlement of the CVR agreement liability and related HMA legal proceedings.

Loss for the six months ended June 30, 2018 included the following:

 

anafter-tax charge of $5 million for government and other legal settlements, net of related legal expenses,

anafter-tax charge of $172 million for the impairment of goodwill and long-lived assets of hospitals sold or held for sale based on their estimated fair values,

anafter-tax charge of $10 million for employee termination benefits and other restructuring costs,

after-tax income of $46 million for gain from early extinguishment of debt, and

anafter-tax charge of $7 million from fair value adjustments on the CVR agreement liability accounted for at fair value related to the HMA legal proceedings, and related legal expenses.

an after-tax charge of $3 million for legal expenses related to the settlement of the HMA Legal Matters.

Consolidated inpatient admissions for the six months ended June 30, 2019,2020, decreased 12.5%18.3%, compared to the six months ended June 30, 2018.2019. Consolidated adjusted admissions for the six months ended June 30, 2019,2020, decreased 12.5%21.0%, compared to the six months ended June 30, 2018.2019. Same-store inpatient admissions for the six months ended June 30, 2019, increased 1.1%2020, decreased 11.5%, compared to the six months ended June 30, 2018,2019, and same-store adjusted admissions for the six months ended June 30, 2019, increased 1.3%2020, decreased 14.5%, compared to the six months ended June 30, 2018.2019. These same-store decreases primarily resulted from the impact of the COVID-19 pandemic.

35


Self-pay revenues represented approximately 1.1%(2.2)% and 0.8%1.1% of net operating revenues for the three months ended June 30, 20192020 and 2018,2019, respectively, and 1.1%(0.5)% and 1.5%1.1% for the six months ended June 30, 20192020 and 2018,2019, respectively. The amount of foregone revenue related to providing charity care services as a percentage of net operating revenues was approximately 4.3%5.5% and 3.2%4.3% for the

three months ended June 30, 2019 and 2018, respectively, and 4.3% and 3.2% for the six months ended June 30, 20192020 and 2018,2019, respectively. Direct and indirect costs incurred in providing charity care services as a percentage of net operating revenues was approximately 0.5%0.7% and 0.4%0.5% for the three months ended June 30, 2019 and 2018, respectively, and 0.5% and 0.4% for the six months ended June 30, 2020 and 2019, and 2018, respectively.

Legislative Overview

The U.S. Congress and certain state legislatures have introduced and passed a large number of proposals and legislation designed to make major changes in the healthcare system, including changes that have increasedimpacted access to health insurance. The most prominent of these recent efforts, the Affordable Care Act, affectsaffected how healthcare services are covered, delivered and reimbursed. It mandates that substantially all U.S. citizens maintain health insurance and increasesThe Affordable Care Act increased health insurance coverage through a combination of public program expansion and private sector health insurance reforms.reforms and mandated that substantially all U.S. citizens maintain health insurance. The Affordable Care Act also made a number of changes to Medicare and Medicaid, such as a productivity offset to the Medicare market basket update and reductions to the Medicare and Medicaid disproportionate share hospital, or DSH, payments.

However, the future of the Affordable Care Act is uncertain. Since the 2016 presidential election, significant changes have been made to the Affordable Care Act, its implementation, and its interpretation. Theinterpretation, and the current presidential administration and certain members of Congress have stated their intent to repeal or make additional significant changes to the law. For example, as part of the tax reform legislation which was enacted in December 2017, the financial penalty associated with the individual mandate was eliminated, effective January 1, 2019, which may result in fewer individuals electing to purchase health insurance. In December 2018, a federal judge in Texas found the entire Affordable Care Act to be unconstitutional as a result of the individual mandate penalty being eliminated. However, the law remains in place pending appeal. In addition, final rules issued in 2018 expand availability of association health plans and allow the sale of short-term, limited-duration health plans, neither of which are required to cover all of the essential health benefits mandated by the Affordable Care Act. TheseAdditionally, effective January 1, 2019, the financial penalty associated with the individual mandate was eliminated as part of the tax reform legislation that was enacted in December 2017. In December 2018, as a result of this change, a federal judge in Texas found the individual mandate unconstitutional and determined the rest of the Affordable Care Act was therefore invalid. In December 2019, the Fifth Circuit Court of Appeals upheld this decision with respect to the individual mandate, but remanded for further consideration of how this affects the rest of the law. Pending the appeals process, the law remains in effect. The elimination of the individual mandate penalty and other changes may impact the number of individuals whothat elect to purchaseobtain public or private health insurance or the scope of such coverage, if purchased.

Of critical importance to us will be the potential impact of any changes specific to the Medicaid program, including the funding and expansion provisions of the Affordable Care Act. We operate hospitals in five of the ten states that experienced the largest reductions in uninsured rates among adult residents between 2013 and 2015. In general,Act or any subsequent legislation or agency initiatives. Historically, the states with the greatest reductions in the number of uninsured adult residents have expanded Medicaid. A number of states have opted out of the Medicaid coverage expansion provisions, but could ultimately decide to expand their programs at a later date. Of the 1817 states in which we operated hospitals as of June 30, 2019,2020, nine states have taken action to expand their Medicaid programs. At this time, the other nineeight states have not, including Florida, Alabama, Tennessee and Texas, where we operated a significant number of hospitals as of June 30, 2019.2020. Some states use, or have applied to use, waivers granted by the Centers for Medicare & Medicaid Services, or CMS, to implement expansion, impose different eligibility or enrollment restrictions, or otherwise implement programs that vary from federal standards. CMS administrators have indicated that they are increasing state flexibility in the administration of Medicaid programs. For example, CMS has granted a limited number of state applications for waivers that allow a state to condition Medicaid enrollment on work or other community engagement. Several states have similar applications pending.

The Affordable Care Act makes a number of 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, and a reduction to the Medicare and Medicaid disproportionate share hospital payments, each of which could adversely impact the reimbursement received under these programs. The Affordable Care Act also includes provisions aimed at reducing fraud, waste and abuse in the healthcare industry.

We believe that the Affordable Care Act has had a positive impact on net operating revenues and income as the result of the expansion of private sector and Medicaid coverage that has occurred. However, legislativeother provisions of the Affordable Care Act, such as requirements related to employee health insurance coverage and changes to Medicare and Medicaid reimbursement, have increased our operating costs or adversely impacted the reimbursement we receive. Legislative and executive branch efforts related to healthcare reform could result in increased prices for consumers purchasing health insurance coverage or the sale of insurance plans that contain gaps in coverage, which could destabilize insurance markets and impact the rates of uninsured or underinsured adults. Other provisionsSome current initiatives and proposals, including those aimed at price transparency and out-of-network charges, may impact prices and the relationships between hospitals and insurers. In addition, members of the Affordable Care Act, such as requirements related to employee health insuranceCongress have proposed measures that would expand government-sponsored coverage, and changes to Medicare and Medicaid reimbursement, have increased our operating costs or adversely impacted the reimbursement we receive.including single-payor models.

It is difficult to predict the ongoing effect of the Affordable Care Act due to executive orders, changes to the law’s implementation, clarifications and modifications resulting from the rule-making process, judicial interpretations resulting from court challenges to its constitutionality and interpretation, whether and how many states ultimately decide to expand Medicaid coverage, the number of uninsured who elect to purchase health insurance coverage, budgetary issues at federal and state levels, and efforts to change or repeal the statute. We may not be able to fully realize the positive impact the Affordable Care Act may otherwise have on our business, results of operations, cash flow, capital resources and liquidity. We cannot predict whether we will be able to modify certain aspects of our operations to offset any potential adverse consequences from the Affordable Care Act or the impact of any alternative provisions that may be adopted.

36


In recent years, a number of laws, including the Affordable Care Act and Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, have promoted shifting from traditionalfee-for-service reimbursement models to alternative payment models that tie reimbursement to quality and cost of care. CMS currently administers various ACOs and bundled payment demonstration projects and has indicated that it will continue to pursue similar initiatives. However, the COVID-19 pandemic may impact provider performance and data reporting under these initiatives. CMS has temporarily modified requirements of certain programs by, for example, extending reporting deadlines.

As a result of the COVID-19 pandemic, federal and state governments have passed legislation, promulgated regulations, and taken other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients during the public health emergency. These measures include temporary relief from Medicare conditions of participation requirements for healthcare providers, temporary relaxation of licensure requirements for healthcare professionals, temporary relaxation of privacy restrictions for telehealth remote communications, promoting use of telehealth by temporarily expanding the scope of services for which Medicare reimbursement is available, and limited waivers of fraud and abuse laws for activities related to COVID-19 during the emergency period.

One of the primary sources of relief for healthcare providers is the CARES Act, an economic stimulus package signed into law on March 27, 2020. The PPPHCE Act, an expansion of the CARES Act that includes additional emergency appropriations, was signed into law on April 24, 2020. Together, the CARES Act and the PPPHCE Act include $175 billion in funding to be distributed through the PHSSEF to eligible providers, including public entities and Medicare- and/or Medicaid-enrolled providers. PHSSEF payments are intended to compensate healthcare providers for lost revenues and incremental expenses incurred in response to the COVID-19 pandemic and are not required to be repaid, provided that recipients attest to and comply with certain terms and conditions, including limitations on balance billing, not using PHSSEF funds to reimburse expenses or losses that other sources are obligated to reimburse and audit and reporting requirements. In addition, the CARES Act expanded the Medicare Accelerated and Advance Payment Program to increase cash flow to providers impacted by the COVID-19 pandemic. Inpatient acute care hospitals may request accelerated payment of up to 100% of their Medicare payment amount for a six-month period. The Medicare Accelerated and Advanced Payment Program payments are advances that providers must repay. CMS must recoup the accelerated payments beginning 120 days after receipt by the provider by withholding future Medicare fee-for-service payments. In April 2020, CMS announced that it is reevaluating new applications from Medicare Part A providers, such as hospitals, for accelerated payments in light of direct payments made available through PHSSEF, and it has suspended the advance payment program for physicians and other Medicare Part B health care providers. The CARES Act also includes other provisions offering financial relief, for example suspending the Medicare sequestration payment adjustment from May 1, 2020 through December 31, 2020, which would have otherwise reduced payments to Medicare providers by 2% (although it extends sequestration through 2030), delaying scheduled reductions to Medicaid DSH payments, providing a 20% add-on to the inpatient PPS DRG rate for COVID-19 patients for the duration of the public health emergency, and permitting the deferral of payment of the employer portion of social security taxes between March 27, 2020 and December 31, 2020, with 50% of the deferred amount due December 31, 2021 and the remaining 50% due December 31, 2022.

During the three months ended June 30, 2020, we received approximately $564 million in payments through the PHSSEF in both general and targeted distributions, net of amounts received for previously divested entities that are required to be repaid to HHS. Approximately $448 million of the PHSSEF payments qualified as reimbursement for lost revenues and incremental expenses and was recognized as a reduction in operating costs and expenses during the three and six months ended June 30, 2020. The PHSSEF payments did not impact net operating revenues, and had a positive impact on net income attributable to Community Health Systems, Inc. common stockholders during the three months ended June 30, 2020, in the amount of $333 million. The portion of the PHSSEF payments that was not recognized as a reduction in operating costs and expenses or refunded as of June 30, 2020 is included within accrued liabilities-other in the condensed consolidated balance sheet, and such unrecognized amounts may be recognized as a reduction in operating costs and expenses in future periods if the underlying conditions for recognition are met. In addition, during July 2020, we have received general and targeted distributions totaling approximately $109 million from the PHSSEF which did not qualify for recognition as a reduction of operating costs and expenses during the three months ended June 30, 2020. With respect to the Medicare Accelerated and Advanced Payment Program, we received Medicare accelerated payments of approximately $1.2 billion in April 2020, which we currently expect will be recouped beginning in August 2020. Medicare accelerated payments are included within accrued liabilities-other in the condensed consolidated balance sheet. Effective April 26, 2020, CMS is reevaluating pending and new applications for accelerated payments in light of significant other relief provided by the CARES Act and the PPPHCE Act. Accordingly, we do not expect to receive additional Medicare accelerated payments.

37


Due to the recent enactment of the CARES Act and the PPPHCE Act, there is still a high degree of uncertainty surrounding their implementation, and the public health emergency continues to evolve. Some of the measures allowing for flexibility in delivery of care and various financial supports for health care providers are available only for the duration of the public health emergency, and it is unclear whether or for how long the public health emergency declaration will be extended. The current declaration expires October 23, 2020. The HHS Secretary may choose to renew the declaration for successive 90-day periods for as long as the emergency continues to exist and may terminate the declaration whenever he determines that the public health emergency no longer exists. The federal government has implemented a numbermay consider additional stimulus and relief efforts, but we are unable to predict whether additional stimulus measures will be enacted or their impact on us. There can be no assurance as to the total amount of financial and other types of assistance we will receive under the CARES Act, PPPHCE Act or future measures, if any, and it is difficult to predict the impact of such measures on our operations or how they will affect operations of our competitors. Further, there can be no assurance that the terms of provider relief funding or other programs will not change or be interpreted in ways that affect our funding or eligibility to participate or our ability to comply with applicable requirements and retain amounts received. We continue to assess the potential impact of the CARES Act, the PPPHCE Act, the potential impact of future stimulus measures, if any, and the impact of other laws, regulations, and programs designed to promote the use of EHR technology and pursuant to the Health Information Technology for Economic and Clinical Health Act, or HITECH, established requirements for a Medicare and Medicaid incentive payments program for eligible hospitals and professionals that adopt and meaningfully use certified EHR technology. These payments are available for a maximum period of five or six years, depending on the program. Our hospital facilities have been implementing EHR technology on afacility-by-facility basis since 2011. We recognize incentive reimbursementguidance related to the Medicare or Medicaid incentives as we are able to implement the certified EHR technologyCOVID-19 on our business, results of operations, financial condition and meet the defined “meaningful use criteria,” and information from completed cost report periods is available from which to calculate the incentive reimbursement.

Eligible hospitals and professionals that have not demonstrated meaningful use of certified EHR technology and have not applied and qualified for a hardship exception are subject to payment adjustments. Eligible hospitals are subject to a reduced market basket update to the inpatient prospective payment system standardized amount as of 2015 and for each subsequent fiscal year. Eligible professionals are subject to payment adjustments based on their meaningful use of certified EHR technology, among other factors, under the Merit-Based Incentive Payment Systems, or MIPS.cash flows.

In June 2019, the U.S. Supreme Court ruled inAzar v. Allina Health Services that the U.S. Department of Health and Human ServicesHHS failed to comply with statutory notice and comment rulemaking procedures before announcing an earlier policy related to disproportionate share hospital, or DSH payments made under Medicare to hospitals. Following this ruling, unless the U.S. Department of Health and Human ServicesHHS is able to successfully assert another legal basis for this policy, one potential outcome is the federal government could be required to reimburse hospitals, including the Company,us, for DSH Medicare payments which otherwise would have been payable over certain prior time periods absent the enactment of this policy. While the ruling in this case was specific to the DSH payments calculated for federal fiscal year 2012 for the plaintiff hospitals, we believe that prior time periods with the potential for higher DSH payments because of the precedent of this ruling could include federal fiscal years 2005 to 2013. There continues to be uncertainty regarding the extent to which, if any, DSH Medicare payments will be remitted to us as the result of this ruling, and if so the timing of any such payments. However, we anticipate that if it is ultimately determined that the Company iswe are entitled to receive such DSH Medicare payments for these prior time periods, these payments could have a material positive impact on anon-recurring basis in theany future period in which net income is recognized in respect thereof as well as on our cash flows from operations in theany future period in which these payments are received.

As a result of our current levels of cash, funds we have received and may in the future receive under the CARES Act, the PPPHCE Act, or any future stimulus measures, available borrowing capacity, long-term outlook on our debt repayments, the refinancing of certain of our term loansnotes, proceeds from the sale of hospitals and our continued projection of our ability to generate cash flows, we anticipate that we will be able to invest the necessary capital in our business over the next twelve months. We believe there continues to be ample opportunity to strengthen our market share in substantially all of our markets by decreasing the need for patients to travel outside their communities for healthcare. Furthermore, we will continue to strive to improve operating efficiencies and procedures in order to improve the performance of our hospitals.

Sources of Revenue

The following table presents the approximate percentages of net operating revenues by payor source for the periods indicated. The data for the periods presented are not strictly comparable due to the effect that hospital acquisitions and divestitures have had on these statistics.

 

          Three Months Ended                  Six Months Ended        
  June 30,  June 30,

 

Three Months Ended

 

 

Six Months Ended

 

  2019  2018  2019  2018

 

June 30,

 

 

June 30,

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Medicare

   24.8 %    26.5 %    25.6 %    27.3 % 

 

 

24.1

%

 

 

24.8

%

 

 

24.6

%

 

 

25.6

%

Medicaid

   13.7        13.5        13.2        12.9     

 

 

13.5

 

 

 

13.7

 

 

 

13.5

 

 

 

13.2

 

Managed Care and other third-party payors

   60.4        59.2        60.1        58.3     

 

 

64.6

 

 

 

60.4

 

 

 

62.4

 

 

 

60.1

 

Self-pay

   1.1        0.8        1.1        1.5     

 

 

(2.2

)

 

 

1.1

 

 

 

(0.5

)

 

 

1.1

 

  

 

  

 

  

 

  

 

Total

   100.0 %    100.0 %    100.0 %    100.0 % 

 

 

100.0

%

 

 

100.0

%

 

 

100.0

%

 

 

100.0

%

  

 

  

 

  

 

  

 

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 andnon-patient service revenue, such as rental income and cafeteria sales. In the future, we generally expect the portion of revenues received from the Medicare and Medicaid programs to increase over the long-term due to the general aging of the population. In addition,population and the impact of the Affordable Care Act. The Affordable Care Act has increased the number of insured patients in states that have expanded Medicaid, which in turn, has reduced the percentage of revenues fromself-pay patients. However, it is unclear whether the trend of increased coverage will continue, due in part to the impact of the COVID-19 pandemic and the elimination of the financial penalty

38


associated with the individual mandate, effective January 1, 2019. Further, the Affordable Care Act imposes significant reductions in amounts the government pays Medicare managed care plans. An executive order issued in October 2019 seeks to accelerate this shift away from traditional fee-for-service Medicare to Medicare managed care. The trend toward increased enrollment in Medicare and Medicaid managed care may adversely affect our operating revenue. Other provisions in the Affordable Care Act imposeWe may also be impacted by regulatory requirements imposed on insurers, such as 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. The trend toward increased enrollment in managed careOur relationships with payors may adversely affect our operating performance.be impacted by price transparency initiatives and out-of-network billing proposals. 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 bynon-governmental payors using a variety of payment methodologies. Amounts we receive for the treatment of patients covered by Medicare, Medicaid andnon-governmental payors are generally less than theour standard billing rates. We account for the differences between the estimated program reimbursement rates and theour 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. Contractual allowance adjustments related to final settlements and previous program reimbursement estimates impacted net operating revenues and net lossincome (loss) by an insignificant amount in each of the three andsix-month periods ended June 30, 20192020 and 2018.2019.

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 2,16, 2019, CMS issued the final rule to increase this index by 3.0% for hospital inpatient acute care services that are reimbursed under the prospective payment system, beginning October 1, 2019. The final rule provides for a 0.4%0.4 percentage point multifactor productivity reduction and a positive 0.5% adjustment0.5 percentage point increase in accordance with MACRA, which, together with other changes to payment policies is expected to yield an estimated net 3.0%average 2.9% increase in reimbursement for hospital inpatient acute care services. An additional reduction applies to hospitals that do not submit required patient quality data. We are complying with this data submission requirement. Payments may also be affected by various other adjustments, such as admission and medical review criteria for inpatient services commonly known as the “two midnight rule.” Under theThis rule for admissions on or after October 1, 2013,limits when services to Medicare beneficiaries are only payable as inpatient hospital services when there is a reasonable expectation that the hospital care is medically necessary and will be required across two midnights, absent unusual circumstances. Stays expected to need less than two midnights of hospital care are subject to medical review on acase-by-case basis.services. Reductions in the rate of increase or overall reductions in Medicare reimbursement may cause a decline in the growth of our net operating revenues.

Currently,Payment rates under the Medicaid program vary by state. In addition to the base payment rates for specific claims for services rendered to Medicaid enrollees, several states utilize supplemental reimbursement programs for the purposeto make separate payments that are not specifically tied to an individual’s care, some of providing reimbursement to providers towhich offset a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed with input from 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. The programs are generally authorized for a specified period of time and require CMS’s approval to be extended. CMS has indicated that it will take into account a state’s status with respect to expanding its Medicaid program in considering whether to extend these supplemental programs. We are unable to predict whether or on what terms CMS will extend the supplemental programs in the states in which we operate. Under these supplemental programs, 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.

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. TheHistorically, the strongest demand for hospital services generally occurs during January through April and the weakest demand for these services generally occurs during the summer months. Accordingly, eliminating the effects of new acquisitions and/or divestitures, our net operating revenues and earnings are historically highest during the first quarter and lowest during the third quarter. As previously noted, the COVID-19 pandemic has disrupted the pattern of demand for services we provide.

39


The following tables summarize, for the periods indicated, selected operating data.

 

          Three Months Ended                 Six Months Ended        

 

Three Months Ended

 

 

Six Months Ended

 

  June 30, June 30,

 

June 30,

 

 

June 30,

 

  2019 2018 2019 2018

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Operating results, as a percentage of net operating revenues:

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net operating revenues

   100.0 %  100.0 %  100.0 %  100.0 % 

 

 

100.0

%

 

 

100.0

%

 

 

100.0

%

 

 

100.0

%

Operating expenses (a)

   (91.0 (89.1 (89.8 (88.9

 

 

(82.2

)

 

 

(91.0

)

 

 

(86.6

)

 

 

(89.8

)

Depreciation and amortization

   (4.6 (5.0 (4.6 (4.9

 

 

(5.6

)

 

 

(4.6

)

 

 

(5.1

)

 

 

(4.6

)

Impairment and gain (loss) on sale of businesses, net

   (1.0 (4.9 (1.1 (2.8
  

 

 

 

 

 

 

 

Impairment and loss on sale of businesses, net

 

 

(0.4

)

 

 

(1.0

)

 

 

(1.0

)

 

 

(1.1

)

Income from operations

   3.4  1.0  4.5  3.4 

 

 

11.8

 

 

 

3.4

 

 

 

7.3

 

 

 

4.5

 

Interest expense, net

   (8.0 (6.6 (7.8 (6.4

 

 

(10.4

)

 

 

(8.0

)

 

 

(9.4

)

 

 

(7.8

)

Loss from early extinguishment of debt

   -  1.8  (0.5 0.8 

 

 

 

 

 

 

 

 

(0.1

)

 

 

(0.5

)

Equity in earnings of unconsolidated affiliates

   0.1  0.2  0.2  0.2 

 

 

 

 

 

0.1

 

 

 

0.1

 

 

 

0.2

 

  

 

 

 

 

 

 

 

Loss before income taxes

   (4.5 (3.6 (3.6 (2.0

Income (loss) before income taxes

 

 

1.4

 

 

 

(4.5

)

 

 

(2.1

)

 

 

(3.6

)

Benefit from (provision for) income taxes

   0.1  1.0  (0.1 0.6 

 

 

2.3

 

 

 

0.1

 

 

 

4.4

 

 

 

(0.1

)

  

 

 

 

 

 

 

 

Net loss

   (4.4 (2.6 (3.7 (1.4

Net income (loss)

 

 

3.7

 

 

 

(4.4

)

 

 

2.3

 

 

 

(3.7

)

Less: Net income attributable to noncontrolling interests

   (0.7 (0.5 (0.6 (0.5

 

 

(0.9

)

 

 

(0.7

)

 

 

(0.7

)

 

 

(0.6

)

  

 

 

 

 

 

 

 

Net loss attributable to Community Health Systems, Inc. stockholders

   (5.1)%  (3.1)%  (4.3)%  (1.9)% 
  

 

 

 

 

 

 

 

Net income (loss) attributable to Community Health

Systems, Inc. stockholders

 

 

2.8

%

 

 

(5.1

)%

 

 

1.6

%

 

 

(4.3

)%

   Three Months Ended Six Months Ended
   June 30, 2019 June 30, 2019

Percentage (decrease) increase from prior year:

   

Net operating revenues

   (7.3)%   (7.9)% 

Admissions

   (11.5  (12.5

Adjusted admissions (b)

   (12.3  (12.5

Average length of stay

   2.3   - 

Net loss attributable to Community Health Systems, Inc.

   51.8   111.1 

Same-store percentage increase from prior year (c):

   

Net operating revenues

   4.9 %   4.0 % 

Admissions

   2.3   1.1 

Adjusted admissions (b)

   1.8   1.3 

 

 

 

Three Months Ended June 30,

 

 

Six Months Ended

June 30,

 

 

 

2020

 

 

2019

 

 

2020

 

 

2019

 

Percentage (decrease) increase from prior year:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net operating revenues

 

 

(23.7

)%

 

 

(7.3

)%

 

 

(17.0

)%

 

 

(7.9

)%

Admissions (b)

 

 

(23.6

)

 

 

(11.5

)

 

 

(18.3

)

 

 

(12.5

)

Adjusted admissions (c)

 

 

(29.2

)

 

 

(12.3

)

 

 

(21.0

)

 

 

(12.5

)

Average length of stay (d)

 

 

2.2

 

 

 

2.3

 

 

 

 

 

 

 

Net income (loss) attributable to Community Health

   Systems, Inc.

 

 

141.9

 

 

 

51.8

 

 

 

130.5

 

 

 

111.1

 

Same-store percentage (decrease) increase from prior year (e):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net operating revenues

 

 

(18.4

)%

 

 

4.9

%

 

 

(10.9

)%

 

 

4.0

%

Admissions (b)

 

 

(18.1

)

 

 

2.3

 

 

 

(11.5

)

 

 

1.1

 

Adjusted admissions (c)

 

 

(24.2

)

 

 

1.8

 

 

 

(14.5

)

 

 

1.3

 

 

(a)

Operating expenses include salaries and benefits, supplies, other operating expenses, government and other legal settlements and related costs, electronic health records incentive reimbursement and lease cost and rent.rent, net of the reduction in operating expenses during the three months ended June 30, 2020, resulting from the receipt and recognition of pandemic relief funds.

(b)

Admissions represents the number of patients admitted for inpatient treatment.

(c)

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)

(d)

Average length of stay represents the average number of days inpatients stay in our hospitals.

(e)

Includes acquired hospitals to the extent we operated them in both periods and excludes our hospitals that have previously been classified as discontinued operations for accounting purposes. In addition, also excludes information for the hospitals sold or closed during 20182019 and the three and six months ended June 30, 2019.2020.

Items (b) – (e) are metrics used to manage our performance. These metrics provide useful insight to investors about the volume and acuity of services we provide, which aid in evaluating our financial results.

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Three Months Ended June 30, 20192020 Compared to Three Months Ended June 30, 20182019

Net operating revenues decreased by 7.3%23.7% to approximately $2.5 billion for the three months ended June 30, 2020, from approximately $3.3 billion for the three months ended June 30, 2019, from approximately $3.6 billion for the three months ended June 30, 2018.2019. Net operating revenues on a same-store basis from hospitals that were operated throughout both periods increased $153decreased $571 million, or 4.9%18.4%, during the three months ended June 30, 2019,2020, as compared to the three months ended June 30, 2018.2019. The increasedecrease in same-store net operating revenues was attributable to improved pricingprimarily due to higher acuity, and an increasea decline in inpatient admissions.volumes resulting from the COVID-19 pandemic. Non-same-store net operating revenues decreased $413$212 million during the three months ended June 30, 2019,2020, in comparison to the prior year period, with the decrease attributable primarily to the impact of the COVID-19 pandemic as well as the divestiture of hospitals during 20182019 and 2019.2020. On a consolidated basis, inpatient admissions decreased by 11.5%23.6% during the three months ended June 30, 20192020 as compared to the three months ended June 30, 2018.2019. Also on a consolidated basis, adjusted admissions decreased by 12.3%29.2% during the three months ended June 30, 20192020 as compared to the three months ended June 30, 2018.2019. On a same-store basis, net operating revenues per adjusted admission increased 3.1%7.6%, while inpatient admissions increaseddecreased by 2.3%18.1% and adjusted admissions increaseddecreased by 1.8%24.2% for the three months ended June 30, 2019,2020, compared to the three months ended June 30, 2018.2019.

Operating costs and expenses, as a percentage of net operating revenues, decreased from 99.0% during the three months ended June 30, 2018 to 96.6% during the three months ended June 30, 2019.2019 to 88.2% during the three months ended June 30, 2020. Operating costs and expenses, excluding depreciation and amortization and impairment and (gain) loss on sale of businesses, as a percentage of net operating revenues, increaseddecreased from 89.1% for the three months ended June 30, 2018 to 91.0% for the three months ended June 30, 2019.2019 to 82.2% for the three months ended June 30, 2020 due to the recognition of approximately $448 million of PHSSEF payments as a reduction of operating costs and expenses during the three months ended June 30, 2020. Salaries and benefits, as a percentage of net operating revenues, decreasedincreased from 45.4% for the three months ended June 30, 2018 to 45.1% for the three months ended June 30, 2019. This decrease in salaries and benefits, as a percentage of net operating revenues, was primarily due2019 to improved staffing and benefit expense management.50.9% for the three months ended June 30, 2020. Supplies, as a percentage of net operating revenues, decreasedincreased from 16.3% for the three months ended June 30, 2019 to 16.6% for the three months ended June 30, 2018 to 16.3% for the three months ended June 30, 2019.2020. Other operating expenses, as a percentage of net operating revenues, increased from 24.7% for the three month ended June 30, 2018 to 27.0% for the three months ended June 30, 2019. This increase in other operating expenses, as a percentage of net operating revenues, was primarily due2019 to the change in estimate for professional liability claims expense and the bad debt expense29.1% for the reserve recorded for a promissory note from the buyer of two of our former hospitals in 2017 that filed for bankruptcy as described above.three months ended June 30, 2020. Expense related to government and other legal settlements and related costs, as a percentage of net operating revenues, increased from less thanremained consistent at 0.1% for both of the three monthsthree-month periods ended June 30, 2018 to 0.1% for the three months ended June 30,2020 and 2019. Lease cost and rent, as a percentage of net operating revenues, increased from 2.4% for the three months ended June 30, 2018 to 2.5% for the three months ended June 30, 2019.2019 to 3.3% for the three months ended June 30, 2020. The increases in salaries and benefits, supplies, other operating expenses and lease cost and rent, as a percentage of net operating revenues, during the three months ended June 30, 2020 compared to June 30, 2019 is primarily due to the impact of the COVID-19 pandemic.

Depreciation and amortization, as a percentage of net operating revenues, decreasedincreased from 5.0% for the three months ended June 30, 2018 to 4.6% for the three months ended June 30, 2019 to 5.6% for the three months ended June 30, 2020, primarily due to ceasing depreciation on property and equipment at hospitals sold or held for sale.a decrease in net operating revenues as a result of the COVID-19 pandemic.

Impairment and (gain) loss on sale of businesses was $10 million for the three months ended June 30, 2020, compared to $33 million for the three months ended June 30, 2019, compared to $174 million for the three months ended June 30, 2018, related to impairment of the long-lived assets and reporting unit goodwill allocated to hospitals classified as held for sale or sold during the respective periods.

Interest expense, net, increaseddecreased by $30$5 million to $260 million for the three months ended June 30, 2020 compared to $265 million for the three months ended June 30, 2019 compared2019. This was primarily due to $235 million for the three months ended June 30, 2018, which was driven by an increasea decrease in interest ratesour average outstanding debt during the three months ended June 30, 2019,2020, which resulted in a decrease in interest expense of $7 million, compared to the same period in 2018, which resulted in2019, and an increase in interest expense of $34 million. Additionally, a decrease in major construction projects during the three months ended June 30, 20192020 resulted in $1$2 million lessmore interest being capitalized, compared to the same period in 2018. 2019.These increasesdecreases were partially offset by a decreasean increase in our average outstanding debtinterest rates which resulted in additional interest expense of $4 million during the three months ended June 30, 2019, which resulted2020 compared to the same period in a decrease in interest expense of $5 million.2019.

No loss from early extinguishment of debt was recognized during the three months ended June 30, 2019. Gain from early extinguishment of debt of $64 million was recognized during the three months ended June 30, 2018, which resulted primarily from the refinancing2020 and exchange of certain of our outstanding notes during that period as discussed further in Capital Resources.2019.

Equity in earnings of unconsolidated affiliates, as a percentage of net operating revenues, decreased from 0.2% during(0.1)% for the three months ended June 30, 20182019 to less than 0.1% duringfor the three months ended June 30, 2019.2020.

The net results of the above-mentioned changes resulted in lossincome (loss) before income taxes increasing $20$184 million from $129 million for the three months ended June 30, 2018 toa loss of $149 million for the three months ended June 30, 2019.

Our benefit frombefore income taxes for the three months ended June 30, 2019 was $3 million compared to $38income before income taxes of $35 million for the three months ended June 30, 2018.2020.

Our benefit from income taxes was $58 million and $3 million for the three months ended June 30, 2020 and 2019, respectively. Our effective tax rates were (165.7)% and 2.0% for the three months ended June 30, 2020 and 29.5%2019, respectively. The tax benefit of $58 million during the three months ended June 30, 2020 is primarily attributable to a change in our projected tax benefit for the annual period ending December 31, 2020.

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Net (loss) income, as a percentage of net operating revenues, was (4.4)% for the three months ended June 30, 2019 and 2018, respectively. The difference in our effective tax ratecompared to 3.7% for the three months ended June 30, 2019, when compared to the three months ended June 30, 2018, was primarily due to an increase in the valuation allowance recognized on IRC Section 163(j) interest carryforwards and thewrite-off ofnon-deductible goodwill.

Net loss, as a percentage of net operating revenues, increased from (2.6)% for the three months ended June 30, 2018 to (4.4)% for the three months ended June 30, 2019.2020.

Net income attributable to noncontrolling interests, as a percentage of net operating revenues, increased from 0.5%0.7% for the three months ended June 30, 20182019 to 0.7%0.9% for the three months ended June 30, 2020.

Net income attributable to Community Health Systems, Inc. was $70 million for the three months ended June 30, 2020, compared to a net loss attributable to Community Health Systems, Inc. of $167 million for the three months ended June 30, 2019.

Net loss attributable to Community Health Systems, Inc. was $167 million for the three months ended June 30, 2019, compared to $110 million for the three months ended June 30, 2018.

Six Months Ended June 30, 20192020 Compared to Six Months Ended June 30, 20182019

Net operating revenues decreased by 7.9%17.0% to approximately $5.5 billion for the six months ended June 30, 2020, from approximately $6.7 billion for the six months ended June 30, 2019, from approximately $7.3 billion for the six months ended June 30, 2018.2019. Net operating revenues on a same-store basis from hospitals that were operated throughout both periods increased $253decreased $679 million, or 4.0%10.9%, during the six months ended June 30, 2019,2020, as compared to the six months ended June 30, 2018.2019. The increasedecrease in same-store net operating revenues was attributable to improved pricingprimarily due to higher acuity, and an increasea decline in inpatient admissions.volumes resulting from the COVID-19 pandemic. Non-same-store net operating revenues decreased $825$456 million during the six months ended June 30, 2019,2020, in comparison to the prior year period, with the decrease attributable primarily to the impact of the COVID-19 pandemic as well as the divestiture of hospitals during 20182019 and 2019.2020. On a consolidated basis, inpatient admissions decreased by 12.5%18.3% during the six months ended June 30, 20192020 as compared to the six months ended June 30, 2018.2019. Also on a consolidated basis, adjusted admissions decreased by 12.5%21.0% during the six months ended June 30, 20192020 as compared to the six months ended June 30, 2018.2019. On a same-store basis, net operating revenues per adjusted admission increased 2.7%4.2%, while inpatient admissions increaseddecreased by 1.1%11.5% and adjusted admissions increaseddecreased by 1.3%14.5% for the six months ended June 30, 2019,2020, compared to the six months ended June 30, 2018.

2019.

Operating costs and expenses, as a percentage of net operating revenues, decreased from 96.6% during the six months ended June 30, 2018 to 95.5% during the six months ended June 30, 2019.2019 to 92.7% during the six months ended June 30, 2020. Operating costs and expenses, excluding depreciation and amortization and impairment and (gain) loss on sale of businesses, as a percentage of net operating revenues, increaseddecreased from 88.9% for the six months ended June 30, 2018 to 89.8% for the six months ended June 30, 2019.2019 to 86.6% for the six months ended June 30, 2020 due to the recognition of approximately $448 million of PHSSEF payments as a reduction of operating costs and expenses during the three months ended June 30, 2020. Salaries and benefits increased as a percentage of net operating revenues from 45.4% for the six months ended June 30, 2019 to 48.5% for the six months ended June 30, 2020. Supplies, as a percentage of net operating revenues, increased from 45.0% for the six months ended June 30, 2018 to 45.4% for the six months ended June 30, 2019. This increase in salaries and benefits, as a percentage of net operating revenues, was primarily due to higher benefits expenses, including health insurance claims cost and an increase in certainnon-qualified benefit plan liabilities from overall market appreciation of plan investments. Supplies, as a percentage of net operating revenues, decreased from 16.7% for the six months ended June 30, 2018 to 16.4% for the six months ended June 30, 2019.2019 to 16.5% for the six months ended June 30, 2020. Other operating expenses, as a percentage of net operating revenues, increased from 24.7% for the six months ended June 30, 2018 to 25.5% for the six months ended June 30, 2019. This increase in other operating expenses, as a percentage of net operating revenues, was primarily due2019 to the change in estimate for professional liability claims expense and the bad debt expense26.7% for the reserve recorded for a promissory note from the buyer of two of our former hospitals in 2017 that filed for bankruptcy as described above.six months ended June 30, 2020. Expense related to government and other legal settlements and related costs, as a percentage of net operating revenues, remained consistent at 0.1% for both of thesix-month periods ended June 30, 20192020 and 2018.2019. Lease cost and rent, as a percentage of net operating revenues, remained consistent atincreased from 2.4% for both of thesix-month periods six months ended June 30, 2019 to 2.9% for the six months ended June 30, 2020. The increases in salaries and 2018.benefits, supplies, other operating expenses and lease cost and rent, as a percentage of net operating revenues, during the six months ended June 30, 2020 compared to June 30, 2019 is primarily due to the impact of the COVID-19 pandemic.

Depreciation and amortization, as a percentage of net operating revenues, decreasedincreased from 4.9% for the six months ended June 30, 2018 to 4.6% for the six months ended June 30, 2019 to 5.1% for the six months ended June 30, 2020, primarily due to ceasing depreciation on property and equipment at hospitals sold or held for sale.a decrease in net operating revenues as a result of the COVID-19 pandemic.

Impairment and (gain) loss on sale of businesses was $56 million for the six months ended June 30, 2020, compared to $71 million for the six months ended June 30, 2019, compared to $202 million for the six months ended June 30, 2018, related to impairment of the long-lived assets and reporting unit goodwill allocated to hospitals classified as held for sale or sold during the respective periods.

Interest expense, net, increased by $58$1 million to $523 million for the six months ended June 30, 2020 compared to $522 million for the six months ended June 30, 2019 compared2019. This was primarily due to $464 million for the six months ended June 30, 2018, which was driven by an increase in interest ratesour debt refinancing activity during the six months ended June 30, 2019, compared to the same period2020 as discussed further in 2018, which resulted in an increase in interest expenseCapital Resources.

Loss from early extinguishment of $71 million. This increasedebt of $4 million was partially offset by a decrease in our average outstanding debtrecognized during the six months ended June 30, 2019, which resulted2020, as a result of the refinancing of certain of our outstanding notes as discussed further in a decrease in interest expense of $11 million, and an increase in major construction projects during the six months ended June 30, 2019 resulted in $2 million more interest being capitalized, compared to the same period in 2018.

Capital Resources. Loss from early extinguishment of debt of $31 million was recognized during the six months ended June 30, 2019, as a result of the Credit Facility amendment and repayment of the term loans under the Credit Facility as discussed further in Capital Resources. Gain from early extinguishment of debt of $59 million was recognized during the six months ended June 30, 2018 which resulted primarily from the refinancing and exchange of certain of our outstanding notes and repayment of a portion of our term loans under the Credit Facility as discussed further in Capital Resources.Facility.

Equity in earnings of unconsolidated affiliates, as a percentage of net operating revenues, remained consistent at 0.2%decreased from (0.2)% for both of thesix-month periods six months ended June 30, 2019 and 2018.to (0.1)% for the six months ended June 30, 2020.

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The net results of the above-mentioned changes resulted in loss before income taxes increasing $100decreasing $128 million from $143 million for the six months ended June 30, 2018 to $243 million for the six months ended June 30, 2019.2019 to $115 million for the six months ended June 30, 2020.

Our provision forbenefit from income taxes for the six months ended June 30, 20192020 was $3$241 million compared to a benefit fromprovision for income taxes of $45$3 million for the six months ended June 30, 2018.2019. Our effective tax rates were 209.6% and (1.2)% and 31.5% for the six months ended June 30, 20192020 and 2018,2019, respectively. The difference in our effective tax rate for the six months ended June 30, 2019,2020, when compared to the six months ended June 30, 2018,2019, was primarily due to changes in tax benefits as a result of an increase into the valuation allowance recognized on IRC Section 163(j)deductible interest carryforwardsexpense allowed for 2019 and 2020 under the write-off of non-deductible goodwill.CARES Act that was enacted during the three months ended March 31, 2020.

Net loss,income (loss), as a percentage of net operating revenues, increased from (1.4)% for the six months ended June 30, 2018 towas (3.7)% for the six months ended June 30, 2019.2019 compared to 2.3% for the six months ended June 30, 2020.

Net income attributable to noncontrolling interests, as a percentage of net operating revenues, increased from 0.5%0.6% for the six months ended June 30, 20182019 to 0.6%0.7% for the six months ended June 30, 2020.

Net income attributable to Community Health Systems, Inc. was $87 million for the six months ended June 30, 2020, compared to a net loss attributable to Community Health Systems, Inc. of $285 million for the six months ended June 30, 2019.

Net loss attributable to Community Health Systems, Inc. was $285 million for the six months ended June 30, 2019, compared to $135 million for the six months ended June 30, 2018.

Liquidity and Capital Resources

Net cash provided by operating activities increased $171 million,$1.4 billion, from approximately $94 million for the six months ended June 30, 2018, to approximately $265 million for the six months ended June 30, 2019.2019, to approximately $1.7 billion for the six months ended June 30, 2020. The increase in cash provided by operating activities wasis primarily the result of lower interestthe receipt of PHSSEF funds under the CARES Act and PPPHCE Act as well as Medicare accelerated payments due to the timing of payments resulting from the refinancing activity during the six months ended June 30, 2019, as well as from an increase in cash flow from patient accounts receivable collections. Such increases were offset by higher malpractice claim payments compared to the same period in 2018.2020. Total cash paid for interest during the six months ended June 30, 2019 decreased2020 increased to approximately $318$486 million compared to $486$318 million for the six months ended June 30, 2018.2019. Cash paid for income taxes, net of refunds received, resulted in a net refund of $3$2 million and $9$3 million during the six months ended June 30, 20192020 and 2018,2019, respectively.

Our net cash used in investing activities wasdecreased $94 million, from approximately $147 million for the six months ended June 30, 2019, compared to approximately $241$53 million for the six months ended June 30, 2018, a decrease of approximately $94 million.2020. The cash used in investing activities during the six months ended June 30, 2019,2020, was primarily impacted by an increase in proceeds from the divestitures of hospitals and other ancillary operations of $73 million in the first six months of 2019 compared to the same period in 2018, and a decrease in the cash used in the purchase of property and equipment of $83$20 million, forand a decrease in the cash used in the acquisition of facilities and other related equipment of $13 million as a result of fewer physician practice, clinic and other ancillary business acquisitions in the first six months ended June 30, 2019of 2020 compared to the same period in 2018.2019 and a decrease in cash used for other investments (primarily from internal-use software expenditures and physician recruiting costs) of $78 million. The decreasesdecrease in cash used in investing activities were also impactedwas partially offset by a decrease in proceeds provided by divestitures of hospitals and other ancillary operations of $9 million as a result of fewer hospital divestitures in the first six months of 2020 compared to the same period in 2019 (including the receipt of the net proceeds for the hospitals divested effective January 1, 2020, on December 31, 2019), and a decrease in cash provided by the net impact of the purchases and sales ofavailable-for-sale securities and equity securities of $12 million, an increase of $3 million in the cash used in the acquisition of facilities and other related equipment as there was a hospital acquisition during the six months ended June 30, 2019, a decrease in the proceeds from sale of property and equipment of $3 million for the six months ended June 30, 2019 compared to the same period in 2018 and an increase in cash used for other investments (primarily frominternal-use software expenditures and physician recruiting costs) of $44$9 million.

Our net cash used in financing activities was $321 million for the six months ended June 30, 2020, compared to approximately $107 million for the six months ended June 30, 2019, compared to approximately $208 million for the six months ended June 30, 2018, a decreasean increase of approximately $101$214 million. The decreaseincrease in cash used in financing activities, in comparison to the prior year period, was primarily due to the net effect of our debt repayment, refinancing activity, and cash paid for deferred financing costs and other debt-related costs.

The CARES Act, which was enacted on March 27, 2020, authorizes $100 billion in funding to hospitals and other healthcare providers to be distributed through the PHSSEF. The PPPHCE Act, which was enacted on April 24, 2020, includes additional emergency appropriations for COVID-19 response, including $75 billion to be distributed to eligible providers through the PHSSEF. Payments from the PHSSEF are intended to compensate healthcare providers for lost revenues and incremental expenses incurred in response to the COVID-19 pandemic and are not required to be repaid provided the recipients attest to and comply with certain terms and conditions, including limitations on balance billing and not using PHSSEF funds to reimburse expenses or losses that other sources are obligated to reimburse. HHS allocated $50 billion of the CARES Act provider relief funding for general distribution to Medicare providers impacted by the COVID-19 pandemic, to be distributed based on providers’ 2018 net patient revenue. In addition, HHS is making targeted distributions for providers in areas particularly impacted by COVID-19, including safety net hospitals, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for testing and treatment of uninsured Americans, among others. HHS has not yet announced the precise method by which all future payments from the PHSSEF will be determined or allocated. We have received payments from the PHSSEF as more specifically described below, and the amount of future payments from the PHSSEF is not currently known.

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As of June 30, 2020, we received approximately $564 million in payments through the PHSSEF in both general and targeted distributions, net of amounts received for previously divested entities that are required to be repaid to HHS. Approximately $448 million of the PHSSEF payments qualified as reimbursement for lost revenues and incremental expenses and was recognized as a reduction in operating costs and expenses during the three and six months ended June 30, 2020. The portion of the PHSSEF payments that was not recognized as a reduction in operating costs and expenses or refunded to HHS as of June 30, 2020 is included within accrued liabilities-other in the condensed consolidated balance sheet, and such unrecognized amounts may be recognized as a reduction in operating costs and expenses in future periods if the underlying conditions for recognition are met. Additionally, we have received approximately $109 million in payments through the PHSSEF in July 2020 which did not qualify for recognition as a reduction of operating costs and expenses during the three months ended June 30, 2020.

As a way to increase cash flow to Medicare providers impacted by the COVID-19 pandemic, the CARES Act expanded the Medicare Accelerated and Advance Payment Program. Inpatient acute care hospitals may request accelerated payments of up to 100% of their anticipated Medicare payment amount for a six-month period (not including Medicare Advantage payments), although CMS is now reevaluating pending and new applications from Medicare Part A providers, including hospitals, in light of direct payments made available through PHSSEF, and has suspended the advance payment program for physicians and other Medicare Part B providers. CMS will base payment amounts for inpatient acute care hospitals on the provider’s Medicare fee-for-service reimbursements in the last six months of 2019. Such accelerated payments are interest free for inpatient acute care hospitals for 12 months, and the program currently requires CMS to recoup the payments beginning 120 days after receipt by the provider, by withholding future Medicare fee-for-service payments for claims until such time as the full accelerated payment has been recouped. The program currently requires the provider must repay any outstanding balance remaining after 12 months or be subjected to an annual interest rate currently set at 10.25%. We received Medicare accelerated payments of approximately $1.2 billion in April 2020 which we currently expect will be recouped beginning in August 2020. Medicare accelerated payments are included within accrued liabilities-other in the condensed consolidated balance sheet.

The CARES Act provides for deferred payment of the employer portion of social security taxes between March 27, 2020 and December 31, 2020, with 50% of the deferred amount due December 31, 2021 and the remaining 50% due December 31, 2022. We began deferring the employer portion of social security taxes in mid-April 2020 and, as of June 30, 2020, have deferred approximately $40 million which is included within other long-term liabilities in the condensed consolidated balance sheet.

There have been no material changes outside of the ordinary course of business to our upcoming cash obligations during the six months ended June 30, 20192020 from those disclosed in the table on page 72 of our 20182019 Form10-K and discussed below related to debt refinancing activity during 2019.2020.

Capital Expenditures

Cash expenditures for purchases of facilities and other related businesses were less than $1 million for the six months ended June 30, 2020, compared to $13 million for the six months ended June 30, 2019, compared to $10 million for the six months ended June 30, 2018.2019. Our expenditures for the six months ended June 30, 2020 and 2019 were primarily related to the purchase of one hospital in Mississippi, physician practices, and other ancillary services. Our expenditures forservices and costs to construct an 18-bed micro-hospital in Arizona. During the six months ended June 30, 2018 were primarily related2020, we had cash expenditures of $19 million that represent both planning and construction costs for the aforementioned micro-hospital. We expect to physician practices and other ancillary services. No hospital acquisitions were completedcommence operations for this micro-hospital during the six months ended June 30, 2018.fourth quarter of 2020.

Excluding the cost to construct replacement hospitals, our cash expenditures for routine capital for the six months ended June 30, 20192020 totaled $206$133 million compared to $294$206 million for the six months ended June 30, 2018.2019. These capital expenditures related primarily to the purchase of additional equipment, minor renovations and information systems infrastructure. Costs to construct replacement hospitals totaled $59 million for the six months ended June 30, 2020, compared to $6 million for the six months ended June 30, 2019, compared to $1 million for the six months ended June 30, 2018.2019. The costs to construct replacement hospitals for the six months ended June 30, 20192020 and 20182019 primarily represent both planning and construction costs for the replacement facility at La Porte, Indiana.

Pursuant to a hospital purchase agreement from our March 1, 2016 acquisition of La Porte Hospital and Starke Hospital, we committed to build replacement facilities in both La Porte, Indiana and Knox, Indiana. Under the terms of such agreement, construction of the replacement hospital for LaPorte Hospital is required to be completed within five years of the date of acquisition, or March 2021. In addition, construction of the replacement facility for Starke Hospital is required to be completed within five years of the date we enter into a new lease with Starke County, Indiana, the hospital lessor, or in the event we do not enter into a new lease with Starke County, construction shall be completed by September 30, 2026. We have not entered into a new lease with the lessor for Starke Hospital and currently anticipate completing construction of the Starke Hospital replacement facility in 2026. Construction costs, including equipment costs, for the La Porte and Starke replacement facilities are currently estimated to be approximately $128 million and $15 million, respectively.

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Capital Resources

Net working capital was approximately $981 million$1.0 billion at June 30, 2019,2020, compared to $1.2$1.1 billion at December 31, 2018.2019. Net working capital decreased by approximately $176$154 million between December 31, 20182019 and June 30, 2019.2020. This decrease iswas primarily due to the increase in current operating leaseother accrued liabilities and decrease in patient accounts receivable, partially offset by an increase in cash, and cash equivalentsdriven by the receipt of PHSSEF funds as well as Medicare accelerated payments, during the six months ended June 30, 2019.2020.

We have senior secured financing under a credit facility with a syndicateIn addition to cash flows from operations, available sources of financial institutions led by Credit Suisse, as administrative agent and collateral agent, which at December 31, 2018 included (i) a revolving credit facility with commitments through January 27, 2021 of approximately $425 million, or the Revolving Facility and (ii) a Term H facility due 2021, or the Term H Facility. The Revolving Facility includes a subfacility for letters of credit.

As of June 30, 2019, the availability for additional borrowingscapital include amounts available under the Credit Facility, subject to certain limitations as set forth in the Credit Facility, was approximately $385 million pursuant to the Revolving Facility, of which $148 million is in the form of outstanding letters of credit. CHS has the ability to amend the Credit Facility to provide for one or more tranches of term loans or increases in the Revolving Facility in an aggregate principal amount of up to $500 million. As of June 30, 2019, the weighted-average interest rate under the Credit Facility, excluding swaps, was 6.4%.

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 NYFRB Rate (as defined) plus 0.50% 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) LIBOR. In addition, the margin in respect of the Revolving Facility will be subject to adjustment determined by reference to a leverage-based pricing grid. Based on our current leverage, loans in respect of the Revolving Facility currently accrue interest at a rate per annum equal to LIBOR plus 2.75%, in the case of LIBOR borrowings, and Alternate Base Rate plus 1.75%, in the case of Alternate Base Rate borrowings. Prior to the refinancing transactions discussed below, the Term H Loan accrued interest at a rate per annum equal to LIBOR plus 3.25%, in the case of LIBOR borrowings, and Alternate Base Rate plus 2.25%, in the case of Alternate Base Rate borrowings. The Term H Loan was subject to a 1.00% LIBOR floor and a 2.00% Alternate Base Rate floor.

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 (as further described below), (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) 75%, subject to reduction to a lower percentage based on our first lien net leverage ratio (as defined in the Credit Facility generally as the ratio of first lien net debt on the date of determination to our consolidated EBITDA, as defined, for the four quarters most recently ended prior to such date), of excess cash flow (as defined) for any year, subject to certain exceptions. Voluntary prepayments and commitment reductions were permitted in whole or in part, without any premium or penalty, subject to minimum prepayment or reduction requirements.

The borrower under the Credit Facility is our wholly-owned subsidiary CHS/Community Health Systems, Inc., or 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 ofnon-significant subsidiaries, syndication subsidiaries, securitization subsidiaries and joint venture subsidiaries. Such assets constitute substantially the same assets, subject to certain exceptions, that secure CHS’ obligations under its outstanding first lien senior secured notes and, on a junior-priority basis, its outstanding junior-priority secured notes.

We have agreed to pay letter of credit fees equal to the applicable percentage then in effect with respect to LIBOR borrowings under the Revolving 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 adjustment based upon our leverage ratio), on the unused portion of the Revolving 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 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 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 maximum first lien net debt to consolidated EBITDA leverage ratio) and various affirmative covenants. Under the Credit Facility, the first lien net debt to consolidated EBITDA leverage ratio is calculated as the ratio of total first lien debt, less unrestricted cash and cash equivalents, to consolidated EBITDA, as defined in the Credit Facility. The calculation of consolidated EBITDA as defined in the Credit Facility is a trailing12-month calculation that begins with net income attributable to us, with certain pro forma adjustments to consider the impact of material acquisitions or divestitures, and adjustments for interest, taxes, depreciation and amortization, net income attributable to noncontrolling interests, stock compensation expense, restructuring costs, and the financial impact of othernon-cash ornon-recurring items recorded during any such12-month period. For the12-month period ended June 30, 2019, the first lien net debt to consolidated EBITDA leverage ratio financial covenant under the Credit Facility limited the ratio of first lien net debt to consolidated EBITDA, as defined, to less than or equal to 5.25 to 1.0. We were in compliance with all such covenants at June 30, 2019, with a first lien net debt to consolidated EBITDA leverage ratio of approximately 4.96 to 1.0.

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 an available cure, (4) bankruptcy and insolvency 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 (as defined), (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.

On February 15, 2019, the Credit Facility was amended, with requisite covenant lender approval, to amend the first lien net debt to EBITDA ratio financial covenant and to reduce the extended revolving credit commitments to $385 million. The amended financial covenant provides for a maximum first lien net debt to EBITDA ratio of 5.00 to 1.0 from July 1, 2018 through December 31, 2018, 5.25 to 1.0 from January 1, 2019 through December 31, 2019, 5.00 to 1.00 from January 1, 2020 through June 30, 2020, 4.50 to 1.00 from July 1, 2020 through September 30, 2020, and 4.25 to 1.0 thereafter. In addition, CHS agreed to further restrict its ability to make restricted payments. The revolving credit commitments will terminate on January 27, 2021. The amended Credit Facility includes a91-day springing maturity date applicable if more than $250 million in the aggregate principal amount of our 8% Senior Notes due 2019, 718% Senior Notes due 2020, Term H Facility or refinancings thereof are scheduled to mature or similarly become due within 91 days of such date.

Prior to the effectiveness of the ABL Facility described below, CHS, through certain of its subsidiaries, participated in 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. Patient-related accounts receivable, or the Receivables, for certain affiliated hospitals served as collateral for the outstanding borrowings under the Receivables Facility. The interest rate on the

borrowings was based on the commercial paper rate plus an applicable interest rate spread. The Receivables Facility was repaid in full and terminated upon the effectiveness of the ABL Facility on April 3, 2018.

On April 3, 2018, we and CHS entered into an asset-based loan (ABL) credit agreement, or the ABL Credit Agreement, with JPMorgan Chase Bank, N.A.,which we entered into on April 3, 2018, as administrative agent,well as anticipated access to public and the lenders and other agents party thereto. private debt markets.

Pursuant to the ABL Credit Agreement, the lenders have extended to CHS/Community Health Systems Inc., or CHS, a revolving asset-based loan facility, or the ABL Facility, in the maximum aggregate principal amount of $1.0 billion, subject to borrowing base capacity. The ABL Facility includesAt June 30, 2020, the available borrowing capacity available for letters of credit of $50 million. CHS and all domestic subsidiaries of CHS that guarantee CHS’ other outstanding senior and senior secured indebtedness guarantee the obligations of CHS under the ABL Facility. Subject to certain exceptions, all obligationsbase under the ABL Facility and the related guarantees are secured by a perfected first-priority security interest in substantially allwas $614 million, of the Receivables, deposit, collection and other accounts and contract rights, books, records and other instruments related to the foregoing of the Company, CHS and the guarantors as well as a perfected junior-priority security interest in substantially all of the other assets of the Company, CHS and the guarantors, subject to customary exceptions and intercreditor arrangements. The revolving credit commitments under the Credit Facility were reduced to $425 million upon the effectiveness of the ABL facility. In connection with entering into the ABL Credit Agreement and the ABL Facility,which we repaid in full and terminated our Receivables Facility. Thehad no outstanding borrowings pursuant to the ABL Facility at June 30, 2019 totaled $723 million on the condensed consolidated balance sheet.

Borrowings under the ABL Facility bear interest at a rate per annum equal to an applicable percentage, plus, at the Borrower’s option, either (a) an Alternative base rate or (b) a LIBOR rate. From and after December 31, 2018, the applicable percentage under the ABL Facility will be determined based on excess availability as a percentageletters of the maximum commitment amount under the ABL facility at a rate per annumcredit issued of 1.25%, 1.50%$180 million. The issued letters of credit were primarily in support of potential insurance-related claims and 1.75% for loans based on the Alternative base rate and 2.25%, 2.50% and 2.75% for loans based on the LIBOR rate. From and after September 30, 2018, the applicable commitment fee rate under the ABL Facility is determined based on average utilization as a percentage of the maximum commitment amount under the ABL Facility at a rate per annum of either 0.50% or 0.625% times the unused portion of the ABL facility.

certain bonds. Principal amounts outstanding under the ABL Facility will be due and payable in full on April 3, 2023. The ABL Facility includes a91-day springing maturity applicable if more than $250 million in the aggregate principal amount of the Borrower’s 8% Senior Notes due 2019, Term G loans due 2019, 7.125% Senior Notes due 2020, Term H loans due 2021, 5.125% Senior Secured Notes due 2021, 6.875% Senior Notes due 2022 or 6.25% Senior Secured Notes due 2023 or refinancings thereof are scheduled to mature or similarly become due on a date prior to April 3, 2023.

The ABL Facility contains customary representations and warranties, subject to limitations and exceptions, and customary covenants restricting our 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) engage in mergers, acquisitions and asset sales, (7) conduct transactions with affiliates, (8) alter the nature of the Company’s, CHS’ or the guarantors’our businesses, (9) grant certain guarantees with respect to physician practices, (10) engage in sale and leaseback transactions or (11) change our fiscal year. We are also required to comply with a consolidated fixed coverage ratio, upon certain triggering events described below, and various affirmative covenants. The consolidated fixed coverage ratio is calculated as the ratio of (x) consolidated EBITDA (as defined in the ABL Facility) less capital expenditures to (y) the sum of consolidated interest expense (as defined in the ABL Facility), scheduled principal payments, income taxes and restricted payments made in cash or in permitted investments. For purposes of calculating the consolidated fixed charge coverage ratio, the calculation of consolidated EBITDA as defined in the ABL Facility is a trailing12-month calculation that begins with our consolidated net income, attributable to Holdings, with certain adjustments for interest, taxes, depreciation and amortization, net income attributable to noncontrolling interests, stock compensation expense, restructuring costs, and the financial impact of othernon-cash ornon-recurring items recorded during any such12-month period. The consolidated fixed charge coverage ratio is a required covenant only in periods where the total borrowings outstanding under the ABL Facility reduce the amount available in the facility to less than the greater of (i) $95 million andor (ii) 10% of the calculated borrowing base. As a result, in the event we have less than $95 million available under the ABL Facility, we would need to comply with the consolidated fixed charge coverage ratio. At June 30, 2019,2020, we were not subject to the consolidated fixed charge coverage ratio as such triggering event had not occurred during the last twelve months ended June 30, 2019.

Events of default under the ABL Facility include, but are not limited to, (1) CHS’ failure to pay principal, interest, fees or other amounts under the ABL 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 an available cure and applicable grace periods, (4) bankruptcy and insolvency 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 (as defined), (8) certain ERISA-related

defaults and (9) the invalidity or impairment of specified security interests, guarantees or subordination provisions in favor of the ABL Agent or lenders under the ABL Facility.2020.

On June 22, 2018,February 6, 2020, CHS completed offers to exchange (i) up to $1.925a private offering of $1.462 billion aggregate principal amount of its new Junior-Priority6⅝% Senior Secured Notes due 2023, orFebruary 15, 2025 (the “6⅝% Senior Secured Notes due 2025”). CHS used the 2023 Junior-Prioritynet proceeds of the offering of the 6⅝% Senior Secured Notes in exchange fordue 2025 to (i) purchase any and all of its $1.925 billion aggregate principal amount5⅛% Senior Secured Notes due 2021 validly tendered and not validly withdrawn in the cash tender offer announced on January 23, 2020, (ii) redeem all of outstanding 8%the 5⅛% Senior Secured Notes (ii) updue 2021 that were not purchased pursuant to $1.200 billionsuch tender offer, (iii) purchase in one or more privately negotiated transactions approximately $426 million aggregate principal amount of its new Junior-Priority Secured Notes due 2024, or the 2024 Junior-Priority Notes, in exchange for any and all of its $1.200 billion aggregate principal amount of outstanding 718% Senior Notes, and (iii) to the extent that less than all of the outstanding 8% Senior Notes and 718% Senior Notes were tendered in the exchange offers, up to an aggregate principal amount of 2024 Junior-Priority Notes equal to, when taken together with the total notes issued in exchange for the validly tendered and accepted 8% Senior Notes and 718% Senior Notes, $3.125 billion, in exchange for its outstanding 678% Senior Notes. Upon completion of the exchange offers, CHS issued (i) approximately $1.770 billion aggregate principal amount of the 2023 Junior-Priority Notes in exchange for the same amount of 8% Senior Notes, (ii) approximately $1.079 billion aggregate principal amount of the 2024 Junior-Priority Notes in exchange for the same amount of 718% Senior Notes and (iii) approximately $276 million aggregate principal amount of the 2024 Junior-Priority Notes in exchange for approximately $368 million of 678% Senior Notes.

On July 6, 2018, CHS completed an offering of $1.033 billion aggregate principal amount of 858% Senior Secured Notes due 2024, or the 858% Senior Secured Notes. We used the proceeds from this offering to repay the outstanding balance owed under the Term G Loan2023 and (iv) pay related fees and expenses related to the offering. expenses.

The terms of the 8586⅝% Senior Secured Notes are governed by an indenture, dated as of July 6, 2018, among CHS, the Company, the subsidiary guarantors party thereto, Regions Bank, as trustee and Credit Suisse AG, as collateral agent. The 858% Senior Secured Notesdue 2025 bear interest at a rate of 858%6.625% per yearannum, payable semi-annually in arrears on JanuaryFebruary 15 and JulyAugust 15 of each year, commencing on JanuaryAugust 15, 2019.2020. The 8586⅝% Senior Secured Notes are scheduled to mature on February 15, 2025. The 6⅝% Senior Secured Notes due 2025 are unconditionally guaranteed on a senior-priority secured basis by us and each of the CHS current and future domestic subsidiaries that provide guarantees under CHS’ senior secured credit facilities, CHS’the ABL facility,Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

On March 6, 2019, CHS completed an offering of $1.601 billion aggregate principal amount of 8% The 6⅝% Senior Secured Notes due 2026, or2025 and the 8% Senior Secured Notes. We usedrelated guarantees are secured by shared (i) first-priority liens on the proceeds from this offeringNon-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to repaypermitted liens described in the outstanding balance owed underindenture governing the Term H Facility and pay fees and expenses related to the offering. The terms of the 8%6⅝% Senior Secured Notes are governed by an indenture, dated as of March 6, 2019, among CHS, the Company, the subsidiary guarantors party thereto, Regions Bank, as trustee and Credit Suisse AG, as collateral agent. The 8% Senior Secured Notes bear interest at a rate of 8% per year payable semi-annually in arrears on March 15 and September 15 of each year, commencing on September 15, 2019. The 8% Senior Secured Notes are unconditionally guaranteed on a senior-priority secured basis by us and each of the CHS current and future domestic subsidiaries that provide guarantees under CHS’ senior secured credit facilities, CHS’ ABL facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.due 2025.

As of June 30, 2019,2020, we are currently a party to one interest rate swap agreementsagreement to limit the effect of changes in interest rates on approximately 96.8%all of our variable rate debt. On each of these swaps, weWe receive a variable rate of interest on this swap based on the three-month London Interbank Offered Rate, or LIBOR, in exchange for the payment by us of a fixed rate of interest. See Note 11 in the footnotes to the condensed consolidated financial statements for further information on our interest rate swap agreements.

The indentures that govern our outstanding notes contain various covenants that limit our ability to take certain actions, including our ability to:45


 

incur, assume or guarantee additional indebtedness;

issue redeemable stock and preferred stock;

repurchase capital stock;

make restricted payments, including paying dividends and making certain loans, acquisitions and investments;

redeem debt that is subordinated in right of payment to our outstanding notes;

create liens;

sell or otherwise dispose of assets, including capital stock of subsidiaries;

impair the security interests;

enter into agreements that restrict dividends and certain other payments from subsidiaries;

merge, consolidate, sell or otherwise dispose of substantially all of our assets;

enter into transactions with affiliates; and

guarantee certain obligations.

The indentures governing each of the 2023 Junior-Priority Notes and 2024 Junior-Priority Notes also prohibit CHS from purchasing, repurchasing, redeeming, defeasing or otherwise acquiring or retiring any outstanding 8% Senior Notes and 718% Senior Notes with: (a) cash or cash equivalents on hand as of the consummation of such exchange offers; (b) cash generated from operations; (c) proceeds from assets sales; or (d) proceeds from the issuance of, or in exchange for, secured debt, in each case, prior to the date that is 60 days prior to the relevant maturity dates of such 8% Senior Notes and 718% Senior Notes, as applicable.

Our ability to meet the restricted covenants and financial ratios and tests in our Credit Facility,the ABL Facility and the indentures governing our outstanding notes 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,the ABL Facility and/or the indentures that govern our outstanding notes. Upon the occurrence of an event of default under our Credit Facility,the ABL Facility or indentures that govern our outstanding notes, all amounts outstanding under our Credit Facility,the ABL Facility and the indentures that govern our outstanding notes may become immediately due and payable and all commitments under the Credit Facility or ABL Facility to extend further credit may be terminated.

As of June 30, 2020, approximately $30 million of our outstanding debt of $13.1 billion is due within the next 12 months.

Any net proceeds from the previously announced portfolio rationalization strategy, which is anticipated to formally conclude in the third quarter of this year, are expected to be used for general corporate purposes.

Through June 30, 2020, we received approximately $1.7 billion of relief payments via the CARES Act, including approximately $564 million in payments through the PHSSEF, net of amounts attributable to previously divested entities, and approximately $1.2 billion of accelerated payments pursuant to the Medicare Accelerated and Advance Payment Program. As previously noted, PHSSEF payments are not required to be repaid, subject to certain terms and conditions, while payments received under the Medicare Accelerated and Advance Payment Program are required to be repaid. Additionally, the CARES Act permits the deferral of payment of the employer portion of social security taxes between March 27, 2020 and December 31, 2020, with 50% of the deferred amount due December 31, 2021 and the remaining 50% due December 31, 2022. As of June 30, 2020, approximately $40 million of social security taxes have been deferred. The deferral of the employer portion of social security taxes along with the funds received under the CARES Act provisions noted above, have positively impacted our cash flows from operations during 2020.

As previously discussed, we may require an increased level of working capital if we experience extended billing and collection cycles resulting from negative economic conditions (including high unemployment and underemployment levels) arising from the COVID-19 pandemic, which may impact service mix, revenue mix, payor mix and patient volumes, as well as our ability to collect outstanding receivables. A material increase in the amount or deterioration in the collectability of accounts receivable will adversely affect our cash flows and results of operations, requiring an increased level of working capital.

We believe that internally generated cash flows and current levels of cash availability for additional borrowingsborrowing under our Credit Facility, of approximately $385 million, of which approximately $148 million is in the form of outstanding letters of credit, the availability under our new ABL Facility and our ability to amend the Credit Facility to provide for one or more incremental tranches of term loans and revolving credit commitments in an aggregate principal amount of up to $500 million, in each case subject to certain limitations as set forth in the Credit Facility, as well as our continued access to the capital markets, will be sufficient to finance acquisitions, capital expenditures, working capital requirements, and any debt repurchases or other debt repayments we may elect to make or be required to make through the next 12 months. PHSSEF funds that we have received and may continue to receive under the CARES Act and the PPPHCE Act, including the approximately $109 million of payments that we have received in July 2020, will be used according to their terms and conditions as reimbursement for lost revenues and incremental expenses attributable to COVID-19, including working capital requirements and capital expenditures. As noted above, the COVID-19 pandemic has resulted in, and may continue to result in, significant disruptions of financial and capital markets, which could reduce our ability to access capital and negatively affect our liquidity in the future. Additionally, while we have received PHSSEF payments and accelerated Medicare payments under the CARES Act and the PPPHCE Act, and may continue to receive PHSSEF payments, as noted above, there is no assurance regarding the extent to which anticipated negative impacts on us arising from the COVID-19 pandemic will be offset by amounts and benefits received or amounts and benefits we may receive in the future under the CARES Act and the PPPHCE Act, or any future measures.

We may elect from time to time to purchase our outstanding debt in open market purchases, privately negotiated transactions or otherwise. Any such debt repurchases will depend upon prevailing market conditions, our liquidity requirements, contractual restrictions, applicable securities laws requirements, and other factors.

Off-balance Sheet Arrangements

Off-balance sheet arrangements consist of letters of credit of $148$180 million issued on our Revolvingthe ABL Facility, primarily in support of potential insurance-related claims and certain bonds, as well as approximately $22$21 million representing the maximum potential amount of future payments under physician recruiting guarantee commitments in excess of the liability recorded at June 30, 2019.2020.

Noncontrolling Interests

We have sold noncontrolling interests in certain of our subsidiaries or acquired subsidiaries with existing noncontrolling interest ownership positions. As of June 30, 2019,2020, we have hospitals in 1710 of the markets we serve, with noncontrolling physician ownership interests ranging from less than 1% to 40%. In addition, as of June 30, 2020, we have eightsix other hospitals with noncontrolling interests owned by non-profit entities. Redeemable noncontrolling interests in equity of consolidated subsidiaries was $503$489 million and $504$502 million as ofat June 30, 20192020 and December 31, 2018,2019, respectively, and noncontrolling interests in equity of consolidated subsidiaries was $74$75 million and $72$77 million as of June 30, 20192020 and December 31, 2018,2019, respectively. The amount of net income attributable to noncontrolling interests was $21$23 million and $19$21 million for the three months ended June 30, 20192020 and 2018,2019, respectively, and $39 million and $37 

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million for both of the six monthssix-month periods ended June 30, 20192020 and 2018, respectively.2019. As a result of the change in the Stark Law “whole hospital” exception included in the Affordable Care Act, we are not permitted to introduce physician ownership at any of our hospital facilities that did not have physician ownership at the time of the adoption of the Affordable Care Act, or increase the aggregate percentage of physician ownership in any of our former or existing hospital joint ventures in excess of the aggregate physician ownership level held at the time of the adoption of the Affordable Care Act.

Reimbursement, Legislative and Regulatory Changes

Ongoing legislative and regulatory efforts could reduce or otherwise adversely affect the payments we receive from Medicare and Medicaid and other payors. Within the statutory framework of the Medicare and Medicaid programs, 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 be adversely impacted. 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 or other restructuring of the financing and delivery of healthcare would have a material adverse effect on our business, financial conditions, results of operations, cash flow, capital resources and liquidity.

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. Moreover, as noted above, we have incurred, and may continue to incur, certain increased expenses arising from the COVID-19 pandemic, including additional labor, equipment, pharmaceutical, medical supplies, and other expenditures.

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.

Revenue Recognition

Upon our adoption of the new revenue recognition standard in the Financial Accounting Standards Board, or FASB, Accounting Standards Codification Topic 606, or ASC 606, weWe record net operating revenues at the transaction price estimated to reflect the total consideration due from patients and third-party payors in exchange for providing goods and services in patient care. These services are considered to be a single performance obligation and have a duration of less than one year. Revenues are recorded as these goods and services are provided. The transaction price, which involves significant estimates, is determined based on our standard charges for the goods and services provided, with a reduction recorded for price concessions related to third party contractual arrangements as well as patient discounts and patient price concessions. During each of the three and six monthsmonth periods ended June 30, 2020 and 2019, the impact of changes to the inputs used to determine the transaction price was considered immaterial to the current period.

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 the Centers for Medicare & Medicaid ServicesCMS and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. Under these supplemental programs, 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 fees, taxes or other program-related costs are reflected in other operating expenses.

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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 bynon-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. Explicit price concessions are recorded for contractual allowances that are calculated and recorded through internally-developed data collection and analysis tools to automate the monthly estimation of required contractual allowances. Within this automated system, 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 is one component of the deductions from gross revenues to arrive at net operating revenues. 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, historical paid claims data and, when applicable, application of the expected managed care plan reimbursement based on contract terms.

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 June 30, 20192020 from our estimated reimbursement percentage, net lossincome (loss) for the six months ended June 30, 20192020 would have changed by approximately $79$76 million, and net accounts receivable at June 30, 20192020 would have changed by $104$97 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. Contractual allowance adjustments related to final settlements and previous program reimbursement estimates impacted net operating revenues and net lossincome (loss) by an insignificant amount for each of the three and six-month periods ended June 30, 20192020 and 2018.2019.

Patient Accounts Receivable

Substantially all of our accounts receivable are related to providing healthcare services to patients at our hospitals and affiliated businesses. 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 andco-payments) owed by the patient. 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 forwalk-in and emergency room patients.

We estimate any adjustments to the transaction price for implicit price concessions by reserving a percentage of allself-pay accounts receivable without regard to aging category, based on collection history, adjusted for expected recoveries and any anticipated changes in trends. Our ability to estimate the transaction price and any implicit price concessions is not impacted by not utilizing an aging of our net accounts receivable as we believe that substantially all of the risk exists at the point in time such accounts are identified asself-pay. The percentage used to reserve for allself-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.

Patient accounts receivable are recorded at net realizable value based on certain assumptions determined by each payor. For third-party payors including Medicare, Medicaid, and Managed Care, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. Forself-pay accounts receivable, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience without regard to aging category. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.

Patient accounts receivable can be impacted by the effectiveness of our collection efforts. Additionally, significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect the net realizable value of accounts receivable. We also continually review the net realizable value of accounts receivable by monitoring historical cash collections as a percentage of trailing net operating revenues, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding, the composition ofself-pay receivables between pureself-pay patients and the patient responsibility portion of third-party insured receivables and the impact of recent acquisitions and dispositions. If the actual collection percentage differed by 1% at June 30, 20192020 from our estimated collection percentage as a result of a change in expected recoveries, net lossincome (loss) for the six months ended June 30, 20192020 would have changed by $52$44 million, and net accounts receivable at June 30, 20192020 would have changed by $69$56 million. We also continually review our overall reserve adequacy by monitoring historical cash collections as a percentage of trailing net operating revenues, as well as by analyzing current period net revenue and admissions by payor classification, days revenue outstanding, the composition ofself-pay receivables between pureself-pay patients and the patient responsibility portion of third-party insured receivables and the impact of recent acquisitions and dispositions.

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Our policy is towrite-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 $4.6$3.5 billion at June 30, 20192020 and $4.7$3.8 billion December 31, 2018,2019, 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 beenwritten-off, they are not included in our accounts receivable. Collections on amounts previouslywritten-off are recognized as a recovery of net operating revenues when received. However, we take into consideration estimated collections of these future amountswritten-off in determining the implicit price concessions used to measure the transaction price for the applicable portfolio of patient accounts receivable.

All of the following information is derived from our hospitals, excluding clinics, unless otherwise noted.

Patient accounts receivable from our hospitals represent approximately 98% of our total consolidated accounts receivable.

Days revenue outstanding, adjusted for the impact of receivables for state Medicaid supplemental payment programs and divested facilities, was 64 days and 58 days at both June 30, 20192020 and December 31, 2018.2019, respectively.

Total gross accounts receivable (prior to allowance for contractual adjustments and implicit price concessions) was approximately $16.9$15.1 billion atas of June 30, 20192020 and $17.2approximately $16.6 billion atas of December 31, 2018.2019. The approximate percentage of total gross accounts receivable (prior to allowance for contractual adjustments and implicit price concessions) summarized by aging categories is as follows:

 

As of June 30, 2019:            
            % of Gross Receivables
 

Payor

        0 - 90 Days            90 - 180 Days          180 - 365 Days          Over 365 Days    
 

Medicare

   14 %    1 %    - %    - % 
 

Medicaid

   7 %    1 %    1 %    1 % 
 

Managed Care and Other

   25 %    4 %    3 %    3 % 
 

Self-Pay

   10 %    8 %    9 %    13 % 
As of December 31, 2018:            
     % of Gross Receivables
 

Payor

  0 - 90 Days  90 - 180 Days  180 - 365 Days  Over 365 Days
 

Medicare

   14 %    - %    - %    - % 
 

Medicaid

   7 %    1 %    1 %    1 % 
 

Managed Care and Other

   26 %    4 %    3 %    3 % 
 

Self-Pay

   9 %    8 %    10 %    13 % 

As of June 30, 2020:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

% of Gross Receivables

 

Payor

 

0 - 90

Days

 

 

90 - 180

Days

 

 

180 - 365

Days

 

 

Over 365

Days

 

Medicare

 

 

14

%

 

 

%

 

 

%

 

 

1

%

Medicaid

 

 

6

%

 

 

1

%

 

 

1

%

 

 

1

%

Managed Care and Other

 

 

28

%

 

 

5

%

 

 

3

%

 

 

3

%

Self-Pay

 

 

5

%

 

 

7

%

 

 

11

%

 

 

14

%

As of December 31, 2019:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

% of Gross Receivables

 

Payor

 

0 - 90

Days

 

 

90 - 180

Days

 

 

180 - 365

Days

 

 

Over 365

Days

 

Medicare

 

 

13

%

 

 

1

%

 

 

%

 

 

1

%

Medicaid

 

 

6

%

 

 

1

%

 

 

1

%

 

 

1

%

Managed Care and Other

 

 

27

%

 

 

4

%

 

 

3

%

 

 

2

%

Self-Pay

 

 

9

%

 

 

8

%

 

 

10

%

 

 

13

%

The approximate percentage of total gross accounts receivable (prior to allowances for contractual adjustments and implicit price concessions) summarized by payor is as follows:

 

        June 30,         December 31,  

 

June 30,

 

 

December 31,

 

  2019 2018

 

2020

 

 

2019

 

Insured receivables

   59.7 %  60.0 % 

 

 

62.9

%

 

 

59.5

%

Self-pay receivables

   40.3  40.0 

 

 

37.1

 

 

 

40.5

 

  

 

 

 

Total

   100.0 %  100.0 % 

 

 

100

%

 

 

100

%

  

 

 

 

The combined total at our hospitals and clinics for the estimated implicit price concessions forself-pay accounts receivable and allowances for otherself-pay discounts and contractuals, as a percentage of grossself-pay receivables, was approximately 89%91% and 90% at June 30, 20192020 and December 31, 2018,2019, respectively. During the three months ended June 30, 2018, we directed the placement with outside collection agencies of approximately $1.3 billion of grossself-pay accounts receivable. Since these receivables were fully reserved at the time ofwrite-off, the overall percentage of reserves for the remainingself-pay accounts receivable decreased. If the receivables that have beenwritten-off, but where collections are still being pursued by outside collection agencies, were included in both the allowances and grossself-pay receivables specified above, the percentage of combined allowances to totalself-pay receivables would have been approximately 94% at both June 30, 20192020 and December 31, 2018.2019.

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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 annually 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. During 2017, we early adopted Accounting Standards Update, or ASU2017-04, which allows a company to record a goodwill impairment when the reporting units carrying value exceeds the fair value determined in step one. Our most recentWe performed our last annual goodwill impairment evaluation was performed during the fourth quarter of 2018 with an2019 using the October 31, 20182019 measurement date, which indicated no impairment.

At June 30, 2019,2020, we had approximately $4.5$4.2 billion of goodwill recorded, all of which resides at our hospital operations reporting unit.

While no impairment was indicated in our most recent annual goodwill evaluation as of the October 31, 20182019 measurement date, the reduction in our fair value and the resulting goodwill impairment charges recorded in 2016 and 2017 reduced the carrying value of our hospital operations reporting unit to an amount equal to our estimated fair value.value as of such prior year measurement dates. This increases the risk that future declines in fair value could result in goodwill impairment. The determination of fair value in step one of our goodwill impairment analysis is based on an estimate of fair value for the hospital operations reporting unit utilizing known and estimated inputs at the evaluation date. Some of those inputs include, but are not limited to, the most recent price of our common stock or fair value of our long-term debt, estimates of future revenue and expense growth, estimated market multiples, expected capital expenditures, income tax rates, and costs of invested capital. A detailed evaluation of potential impairment indicators was performed as of June 30, 2020, which specifically considered the volatility of the fair market value of the Company’s outstanding senior secured and unsecured notes and common stock during the six months ended June 30, 2020, as well as declines in patient volumes and net operating revenues resulting from the COVID-19 pandemic. On the basis of available evidence as of June 30, 2020, no impairment indicators were identified.

Future estimates of fair value could be adversely affected if the actual outcome of one or more of thesethe assumptions described above changes materially in the future, including furthera decline in or volatility of our stock price orand the fair value of its our long-term debt, lower than expected hospital volumes, higher market interest rates or increased operating costs. Such changes impacting the calculation of our fair value, the risks of which are amplified by the COVID-19 pandemic, could result in a material impairment charge in the future.

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.

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 areout-of-pocket and directly related to such liability claims. These directout-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 ourin-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 an approximately20-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.

The net present value of the projected payments was discounted using a weighted-average risk-free rate 3.1%, 2.2%of 1.9% as of June 30, 2020 and 1.8%2.6% and 3.1% in 2018, 20172019 and 2016,2018, 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 loss.income (loss).

50


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 three and four 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 approximately 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 HMA 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 historically produced reliably determinable estimates of ultimate paid losses. Management considers any changes in the amount and pattern of its historical paid losses up through the most recent reporting period

to identify any fundamental shifts or trends in claim development experience in determining the estimate of professional liability claims. However, due to the subjective nature of this estimate and the impact that previously unforeseen shifts in actual claim experience can have, future estimates of professional liability could be adversely impacted when actual paid losses develop unexpectedly based on assumptions and settlement events that were not previously known or anticipated.

During the six months ended June 30, 2019, we experienced a significant increase in the amounts paid to settle outstanding professional liability claims, compared to the same period in the prior year and to previous actuarially determined estimates. This increase in claims paid related to claims incurred in 2016 and prior years and was primarily related to divested hospitals. The settlement of these claims at amounts greater than the previously determined actuarial estimates resulted in us recording a $70 million change in estimate during the six months ended June 30, 2019.

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 less than $1 million per occurrence self-insured retention and for claims reported from June 1, 2002 through June 1, 2003, these self-insured retentions were $2 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 and before June 1, 2014 are self-insured up to $5 million per claim. Substantially all claims reported on or after June 1, 2014 and before June 1, 2018 are self-insured up to $10 million per claim. Substantially all claims reported on or after June 1, 2018 are self-insured up to $15 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 reported on or after January 1, 2008, up to $195 million per occurrence and in the aggregate for claims reported on or after June 1, 2010, and up to $220at least $215 million per occurrence and in the aggregate for claims reported on or after June 1, 2015. In addition, for integrated occurrence malpractice claims, there is an additional $50 million of excess coverage for claims reported on or after June 1, 2014 and an additional $75 million of excess coverage for claims reported on or after June 1, 2015.2015 through June 1, 2020. The $75 million in integrated occurrence coverage will also apply to claims reported between June 1, 2020 and May 31, 2021 for events that occurred prior to June 1, 2020 but which were not previously known or reported. For certain policy years prior to June 1, 2014, if the first aggregate layer of excess coverage becomes fully utilized, then the self-insured retention will increase to $10 million per claim for any subsequent claims in that policy year until our total aggregate coverage is met. Beginning June 1, 2018, this drop-down provision in the excess policies attaches over the $15 million per claim self-insured retention.

51


Effective June 1, 2014, the hospitals acquired from HMA were insured on a claims-made basis as described above and through commercial insurance companies as described above for substantially all claims reported on or after June 1, 2014 except for physician-related claims with an occurrence date prior to June 1, 2014. Prior to June 1, 2014, the former HMA hospitals obtained insurance coverage through a wholly-owned captive insurance subsidiary and a risk retention group subsidiary which are domiciled in the Cayman Islands and South Carolina, respectively. Those insurance subsidiaries, which are collectively referred to as the “Insurance Subsidiaries,” provided (i) claims-made coverage to all of the former HMA hospitals and (ii) occurrence-basis coverage to most of the physicians employed by the former HMA hospitals. The employed physicians not covered by the Insurance Subsidiaries generally maintained claims-made policies with unrelated third party insurance companies. To mitigate the exposure of the program covering the former HMA hospitals and other healthcare facilities, the Insurance Subsidiaries bought claims-made reinsurance policies from unrelated third parties for claims above self-retention levels of $10 million or $15 million per claim, depending on the policy year.

Effective January 1, 2008, the former Triad hospitals were 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, 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 were no significant changes in our estimate of the reserve for professional liability claims during the six months ended June 30, 2020.

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 $1 million as of June 30, 2019.2020. A total of approximately $1 million of interest and penalties is included in the amount of liability for uncertain tax positions at June 30, 2019.2020. It is our policy to recognize interest and penalties related to unrecognized benefits in our condensed consolidated statements of lossincome (loss) as income tax expense.

It is possible the amount of unrecognized tax benefit could change in the next 12 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 condensed consolidated results of operations or condensed consolidated financial position.

Our federal income tax returns for the 2009 and 2010 tax years have been settled with the Internal Revenue Service. The results of these examinations were not material to our consolidated results of operations or consolidated financial position. Our federal income tax returns for the 2014 and 2015 tax years remain under examination by the Internal Revenue Service. We believe the results of these examinations will not be material to our consolidated results of operations or consolidated financial position. We have extended the federal statute of limitations through December 31, 2020June 30, 2021 for Community Health Systems, Inc. for the tax periods ended December 31, 2014 and 2015. Our federal income tax return for the 2018 tax year is under examination by the Internal Revenue Service.

Recent Accounting Pronouncements

In August 2018,March 2020, the FASB issued Accounting Standards Update, or ASU,2018-15 2020-04, or Reference Rate Reform: Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides optional expedients and exceptions for applying GAAP to provide guidance on the accounting for implementation costs incurred in a cloud computing arrangement (CCA)contract modifications and hedging relationships, subject to meeting certain criteria that reference LIBOR or another rate that is a service contract. Thisexpected to be discontinued. The amendments in the ASU requires entities to account for such costs consistent with the guidance on capitalizing costs associated with developing or obtaininginternal-use software. The ASU isare effective for all entities for fiscal years beginning afteras of March 12, 2020 through December 15, 2019, and interim periods within those fiscal years, with early adoption permitted. We are currently evaluating the impact that31, 2022. The adoption of this ASU willguidance did not have a material impact on our condensed consolidated financial position andor results of operations.

We have evaluated all other recently issued, but not yet effective, ASUs and do not expect the eventual adoption of these ASUs to have a material impact our condensed consolidated financial position or results of operations.

52


FORWARD-LOOKING STATEMENTS

Some of the matters discussed in this Report include forward-looking statements.“forward-looking statements” within the meaning of the federal securities laws, which involve risks, assumptions and uncertainties. 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, among other things:

developments related to COVID-19, including, without limitation, related to the length and severity of the pandemic; the volume of canceled or rescheduled procedures; the volume of COVID-19 patients cared for across our health systems; the timing and availability of effective medical treatments and vaccines; measures we are taking to respond to the COVID-19 pandemic; the impact of government and administrative regulation on us; changes in net revenue due to patient volumes, payor mix and negative macroeconomic conditions; increased expenses related to labor, supply chain or other expenditures; workforce disruptions; and supply shortages and disruptions;

uncertainty regarding the implementation of the CARES Act, the PPPHCE Act, and any other future stimulus measures related to COVID-19, including the magnitude and timing of any future payments or benefits we may receive or realize thereunder;

general economic and business conditions, both nationally and in the regions in which we operate, including economic and business conditions resulting from the COVID-19 pandemic;

the impact of current or future federal and state health reform initiatives, including, without limitation, the Affordable Care Act, and the potential for the Affordable Care Act to be repealed or found unconstitutional or otherwise invalidated, or for additional changes to the law, its implementation or its interpretation (including through executive orders and court challenges);

the extent to and manner in which states support increases, decreases or changes in Medicaid programs, implement health insurance exchanges or alter the provision of healthcare to state residents through regulation or otherwise;

the future and long-term viability of health insurance exchanges and potential changes to the beneficiary enrollment process;

risks associated with our substantial indebtedness, leverage and debt service obligations, including our ability to refinance such indebtedness on acceptable terms or to incur additional indebtedness, and our ability to remain in compliance with debt covenants, as well as risks associated with disruptions in the financial and capital markets as the result of the COVID-19 pandemic which could impact us from a financing and liquidity perspective;

demographic changes;

changes in, or the failure to comply with, federal, state or local laws or governmental regulations affecting our business, including any such laws or governmental regulations which are adopted in connection with the COVID-19 pandemic;

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 provider arrangements with payors and the terms of these arrangements, which may be further affected by the increasing consolidation of health insurers and managed care companies and vertical integration efforts involving payors and healthcare providers;

changes in, or the failure to comply with, contract terms with payors and changes in reimbursement policies or rates paid by federal or state healthcare programs or commercial payors;

any potential additional impairments in the carrying value of goodwill, other intangible assets, or other long-lived assets, or changes in the useful lives of other intangible assets;

changes in inpatient or outpatient Medicare and Medicaid payment levels and methodologies;

the effects related to the continued implementation of the sequestration spending reductions and the potential for future deficit reduction legislation;

53


 

increases in the amount and risk of collectability of patient accounts receivable, including decreases in collectability which may result from, among other things, self-pay growth and difficulties in recovering payments for which patients are responsible, including co-pays and deductibles;

the efforts of insurers, healthcare providers, large employer groups and others to contain healthcare costs, including the trend toward value-based purchasing;

increases in wages as a result of inflation or competition for highly technical positions and rising supply and drug 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 or via telehealth;

changes in medical or other technology;

changes in U.S. GAAP;

the availability and terms of capital to fund any additional acquisitions or replacement facilities or other capital expenditures;

our ability to successfully make acquisitions or complete divestitures, including the disposition of hospitals and non-hospital businesses pursuant to our portfolio rationalization and deleveraging strategy, our ability to complete any such acquisitions or divestitures on desired terms or at all, the timing of the completion of any such acquisitions or divestitures, and our ability to realize the intended benefits from any such acquisitions or divestitures;

the impact that changes in our relationships with joint venture or syndication partners could have on effectively operating our hospitals or ancillary services or in advancing strategic opportunities;

our ability to successfully integrate any acquired hospitals, or to recognize expected synergies from acquisitions;

the impact of seasonal severe weather conditions, including the timing and amount of insurance recoveries in relation to severe weather events;

our ability to obtain adequate levels of insurance, including general liability, professional liability, and directors and officers liability insurance;

timeliness of reimbursement payments received under government programs;

effects related to pandemics, epidemics, or outbreaks of infectious diseases, including the novel coronavirus causing the disease known as COVID-19 as noted above;

the impact of cyber-attacks or security breaches;

any failure to comply with the terms of the Corporate Integrity Agreement;

the concentration of our revenue in a small number of states;

our ability to realize anticipated cost savings and other benefits from our current strategic and operational cost savings initiatives;

changes in interpretations, assumptions and expectations regarding the Tax Cuts and Jobs Act; and

the other risk factors set forth in our 2019 Form 10-K, our Quarterly Report on Form 10-Q filed with the SEC on April 29, 2020, and our other public filings with the SEC.

general economic and business conditions, both nationally and in the regions in which we operate;54


 

the impact of current or future federal and state health reform initiatives, including, without limitation, the Affordable Care Act, and the potential for the Affordable Care Act to be repealed or found unconstitutional or for additional changes to the law, its implementation or its interpretation (including through executive orders and court challenges);

the extent to which states support increases, decreases or changes in Medicaid programs, implement health insurance exchanges or alter the provision of healthcare to state residents through regulation or otherwise;

the future and long-term viability of health insurance exchanges and potential changes to the beneficiary enrollment process;

risks associated with our substantial indebtedness, leverage and debt service obligations, and the fact that a substantial portion of our indebtedness will mature and become due in the near future, including our ability to refinance such indebtedness on acceptable terms or to incur additional indebtedness;

demographic changes;

changes in, or the failure to comply with, federal, state or local laws or governmental regulations affecting our business;

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 provider arrangements with payors and the terms of these arrangements, which may be further affected by the increasing consolidation of health insurers and managed care companies and vertical integration efforts involving payors and healthcare providers;

changes in, or the failure to comply with, contract terms with payors and changes in reimbursement rates paid by federal or state healthcare programs or commercial payors;

any potential additional impairments in the carrying value of goodwill, other intangible assets, or other long-lived assets, or changes in the useful lives of other intangible assets;

changes in inpatient or outpatient Medicare and Medicaid payment levels and methodologies;

the effects related to the continued implementation of the sequestration spending reductions and the potential for future deficit reduction legislation;

increases in the amount and risk of collectability of patient accounts receivable, including decreases in collectability which may result from, among other things,self-pay growth and difficulties in recovering payments for which patients are responsible, includingco-pays and deductibles;

the efforts of insurers, healthcare providers, large employer groups and others to contain healthcare costs, including the trend toward value-based purchasing;

increases in wages as a result of inflation or competition for highly technical positions and rising supply and drug 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 any additional acquisitions or replacement facilities or other capital expenditures;

our ability to successfully make acquisitions or complete divestitures, including the disposition of hospitals andnon-hospital businesses pursuant to our portfolio rationalization and deleveraging strategy, our ability to complete any such acquisitions or divestitures on desired terms or at all, the timing of the completion of any such acquisitions or divestitures, and our ability to realize the intended benefits from any such acquisitions or divestitures;

the impact that changes in our relationships with joint venture or syndication partners could have on effectively operating our hospitals or ancillary services or in advancing strategic opportunities;

our ability to successfully integrate any acquired hospitals, or to recognize expected synergies from acquisitions;

the impact of seasonal severe weather conditions, including the timing and amount of insurance recoveries in relation to severe weather events;

our ability to obtain adequate levels of insurance, including general liability, professional liability, and directors and officers liability insurance;

timeliness of reimbursement payments received under government programs;

effects related to outbreaks of infectious diseases;

the impact of prior or potential future cyber-attacks or security breaches;

any failure to comply with the terms of the Corporate Integrity Agreement;

the concentration of our revenue in a small number of states;

our ability to realize anticipated cost savings and other benefits from our current strategic and operational cost savings initiatives;

changes in interpretations, assumptions and expectations regarding the Tax Cuts and Jobs Act; and

the other risk factors set forth in our 2018 Form10-K, and our other public filings with the SEC.

Although we believe that these forward-looking statements are based upon reasonable assumptions, these assumptions are inherently subject to significant regulatory, economic and competitive uncertainties and contingencies, which are difficult or impossible to predict accurately and may be beyond our control. Accordingly, we cannot give any assurance that our expectations will in fact occur, and we caution that actual results may differ materially from those in the forward-looking statements. 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 undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise.

Item 3.Quantitative and QualitativeQualitative Disclosures about Market Risk

We are exposed to interest rate changes, primarily as a result of our Creditthe ABL 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 to manage our exposure to these fluctuations, as described under the heading “Liquidity and Capital Resources” in Part I, 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 of June 30, 2019,2020, our approximately $700 millionone outstanding interest rate swap agreement with a notional amount of interest rate swap agreements outstanding represented approximately 96.8%$300 million and a termination date of August 30, 2020, exceeded our remaining variable rate debt.

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 approximatelyless than $1 million for both of the three-month periods ended June 30, 2020 and 2019, and less than $1 million and $3 million for the three months ended June 30, 2019 and 2018, respectively, andapproximately $2 million and $6 million for the six months ended June 30, 20192020 and 2018,2019, respectively.

Item 4.Controls andControls 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 Rules13a-15(e) and15d-15(e)) under the Securities and Exchange Act of 1934, as amended, 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 SEC’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 three months ended June 30, 20192020 that have materially affected or are reasonably likely to materially affect our internal controls over financial reporting.

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PART II OTHER INFORMATION

From time to time, we receive inquiries or subpoenas from state regulators, state Medicaid Fraud Control units, fiscal intermediaries, the Centers for Medicare and Medicaid Services, the Department of Justice and other government entities regarding various Medicare and Medicaid issues. In addition to the matters discussed below, we are currently responding to subpoenas and administrative demands concerning (a)  an inquiry regarding sleep labs at two Louisiana hospitals (one formerly owned), (b) a civil investigative demand concerning short-term Medicaid eligibility determinations processed by third party vendors at one of our Pennsylvania hospitals, (c) a subpoena related to certain services provided by a formerly-employed physician to Medicaid beneficiaries at one of our New Mexico hospitals, (d)(b) an inquiry regarding certain services performed by one of our affiliated emergency services companies in Pennsylvania, and (e) an inquiry(c) a civil investigative demand related to certaincall coverage services provided to Medicaid beneficiariesby a cardiology group at one of our TexasTennessee hospitals; and (d) a civil investigative demand related to charges for certain emergency department services at our four New Mexico hospitals. In addition, we are subject to other claims and lawsuits arising in the ordinary course of our business including lawsuits and claims related to billing practices and the administration of charity care policies at our hospitals. Based on current knowledge, management does not believe that loss contingencies arising from pending legal, regulatory and governmental matters, including the matters described herein, will have a material adverse effect on the consolidated financial position or liquidity of the Company. However, in light of the inherent uncertainties involved in pending legal, regulatory and governmental matters, some of which are beyond our control, and the very large or indeterminate damages sought in some of these matters, an adverse outcome in one or more of these matters could be material to our results of operations or cash flows for any particular reporting period. 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. In September 2014, the Criminal Division of the United States Department of Justice, or DOJ, announced that all qui tam cases will be shared with their Division to determine if a parallel criminal investigation should be opened. The Criminal Division has also frequently stated an intention to pursue corporations in criminal prosecutions. From time to time, we detect issues ofnon-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.

The following legal proceedings are described in detail because, although they may not be required to be disclosed in this Part II, Item 1 under SEC rules, due to the nature of the business of the Company, we believe that the following discussion of these matters may provide useful information to security holders. This discussion does not include claims and lawsuits covered by medical malpractice, general liability or employment practices insurance and risk retention programs, none of which claims or lawsuits would in any event be required to be disclosed in this Part II, Item 1 under SEC rules. Certain of the matters referenced below are also discussed in Note 1513 of the Notes to Consolidated Financial Statements included under Part I, Item 1 of this Form10-Q.

Shareholder Litigation

2011 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. In lieu of ruling on our motion to dismiss, the court permitted the plaintiffs to file a first amended consolidated class action complaint which was filed on October 5, 2015. Our motion to dismiss was filed on November 4, 2015 and oral argument took place on April 11, 2016. Our motion to dismiss was granted on June 16, 2016 and on June 27, 2016, the plaintiffs filed a notice of appeal to the Sixth Circuit Court of Appeals. The matter was heard on May 3, 2017. On December 13, 2017, the Sixth Circuit reversed the trial court’s dismissal of the case and remanded it to the District Court. We filed a renewed partial motion to dismiss on February 9, 2018, which was denied by the District Court on September 24, 2018. We also filed a petition for writ of certiorari with the United States Supreme Court on April 18, 2018 seeking review of the Sixth Circuit’s decision. The United States Supreme Court denied the petition for a writ of certiorari on October 1, 2018. The District Court granted

the Plaintiff’s motion for class certification on July 26, 2019. We believe this consolidated matter is without meritfiled a petition for permission to appeal the District Court’s class certification order in the Sixth Circuit Court of Appeals on August 9, 2019, and will vigorously defend this case.that petition was denied on October 23, 2019. On January 21, 2020, the Company and the Plaintiff filed a stipulation of settlement indicating to the District Court that the parties had reached agreement on the principal terms of a settlement for $53 million, which was recognized during the three months ended

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December 31, 2019. The settlement received preliminary approval from the District Court on January 30, 2020. On June 22, 2020, the District Court granted final approval of the settlement and ordered the case dismissed with prejudice.

Caleb Padilla, individually and on behalf of all others similarly situated v Community Health Systems, Inc., Wayne T. Smith, Larry Cash, and Thomas JJ. Aaron. This purported federal securities class action was filed in the United States District Court for the Middle District of Tennessee on May 30, 2019. It seeks class certification on behalf of purchasers of our common stock between February 20, 2017 and February 27, 2018 and alleges misleading statements resulted in artificially inflated prices for our common stock. No responsive pleading is due to the complaint at this time, pendingOn November 20, 2019, the District Court’s appointment of a Lead PlaintiffCourt appointed Arun Bhattacharya and Michael Gaviria as lead plaintiffs in the action.case. The lead plaintiffs filed a consolidated class complaint on January 21, 2020. The Company filed a motion to dismiss the consolidated class complaint on March 23, 2020. That motion is pending. We believe this matter is without merit and will vigorously defend this case.

PadillaDerivative Litigation. Five purported shareholder derivative cases have been filed in two District Courts relating to the factual allegations in the Padillalitigation; namely, Faisal Hussain v. Wayne T. Smith, et al, filed August 12, 2019 in the United States District Court for the District of Delaware; Roger Trombley v. Wayne T. Smith, et al, filed August 20, 2019 in the United States District Court for the Middle District of Tennessee; Susheel Tanjavoor v. Wayne T. Smith, et al., filed August 29, 2019, in the United States District Court for the District of Delaware; Roofers Local No. 149 Pension Fund v. John A. Clerico, et al, filed October 30, 2019, in the United States District Court for the District of Delaware; and Kevin Aronson v. Wayne T. Smith, et al, filed April 29, 2020 in the United States District Court for the District of Delaware. All five seek relief derivatively and on behalf of Community Health Systems, Inc. against certain Company officers and directors based on alleged breaches of fiduciary duty, unjust enrichment, and other acts related to certain Company disclosures in 2017 and 2018 regarding the Company’s adoption of Accounting Standards Update 2014-09, which the Company adopted effective January 1, 2018. All five cases have been stayed by agreement.

Other Government Investigations

Florida LIP Program CIDs – On September 14, 2017, our hospital in St. Petersburg, Florida received a CID from the United States Department of Justice for information concerning its historic participation in the Florida Low Income Pool Program. The Low Income Pool Program, or LIP, is a funding pool to support healthcare providers that provide uncompensated care to Florida residents who are uninsured or underinsured. The CID sought documentation related to agreements between the hospital and Pinellas County. On June 13, 2019, an additional ten of our affiliated hospitals in Florida received CIDs related to the same subject matter, along with two CIDs addressed to our affiliated management company and the parent company. We are cooperating fully with this investigation.

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, which was dismissed by the agency and was appealed to an administrative law judge for a hearing that occurred onJanuary 19-26, 2016. In a decision dated November 9, 2016, the law judge awarded Becker approximately $1.9 million for front pay, back pay and emotional damages with attorney fees to be later determined. We have appealed the award to the Administrative Review Board and are awaiting its decision. At a hearing on July 27, 2012, the trial court dismissed Community Health Systems, Inc. from the state case and subsequently certified the state case for an interlocutory appeal of the denial to dismiss his employer and the management company. The appellate court accepted the interlocutory appeal, and it was argued on April 30, 2014. On August 14, 2014, the court denied our appeal. On October 20, 2014, we filed a petition to review the denial with the Washington Supreme Court. Our appeal was accepted and oral argument was heard on June 9, 2015. On September 15, 2015, the court denied our appeal and remanded to the trial court; a previous trial setting of September 12, 2016 has been vacated and not reset. We continue to vigorously defend these actions.

Cyber Attack. As previously disclosed on a Current Report on Form8-K filed by us on August 18, 2014, our computer network was the target of an external, criminal cyber-attack that we believe occurred between April and June, 2014. We and Mandiant (a FireEye Company), the forensic expert engaged by us in connection with this matter, believe the attacker was a foreign “Advanced Persistent Threat” group who used highly sophisticated malware and technology to attack our systems. The attacker was able to bypass our security measures and successfully copy and transfer outside the Company certainnon-medical patient identification data (such as patient names, addresses, birthdates, telephone numbers and social security numbers), but not including patient credit card, medical or clinical information. We worked closely with federal law enforcement authorities in connection with their investigation and prosecution of those determined to be responsible for this attack. Mandiant has conducted a thorough investigation of this incident and continues to advise us regarding security and monitoring efforts. We have provided appropriate notification to affected patients and regulatory agencies as required by federal and state law. We have offered identity theft protection services to individuals affected by this attack.

We have incurred certain expenses to remediate and investigate this matter. In addition, multiple purported class action lawsuits have been filed against us and certain subsidiaries. These lawsuits allege that sensitive information was unprotected and inadequately encrypted by us. The plaintiffs claim breach of contract and other theories of recovery, and are seeking damages, as well as restitution for any identity theft. On February 4, 2015, the United States Judicial Panel on Multidistrict Litigation ordered the transfer of the purported class actions pending outside of the District Court for the Northern District of Alabama to the District Court for the Northern District of Alabama for coordinated or consolidated pretrial proceedings. A consolidated complaint was filed and we filed a motion to dismiss on September 21, 2015, which was partially argued on February 10, 2016. In an oral ruling from the bench, the court greatly limited the potential class by ruling only plaintiffs with specific injury resulting from the breach had standing to sue. Further, on jurisdictional grounds, the court dismissed Community Health Systems, Inc. from allnon-Tennessee based cases. Finally, the court set April 15, 2016 for further argument on whether the remaining plaintiffs have sufficiently stated a cause of action to continue their cases. On April 15, 2016 in an oral ruling from the bench, the court dismissed additional claims and following this oral ruling only eight of the forty plaintiffs remained, with significant limitations imposed on their ability to assert claims for damages. These oral rulings were confirmed in a written order filed on September 12, 2016. On October 20, 2016, the plaintiffs filed a renewed motion for interlocutory appeal from the motion to dismiss ruling and on February 15, 2017 this motion was denied. Plaintiffs refiled their motion for permission to seek interlocutory appeal on March 15, 2017, and that motion was also denied. We have settled these class action lawsuits, and the settlement has been approved by the District Court. Notices of the settlement and claim forms have been mailed to purported class members. The deadline for purported class members to opt out of or object to the settlement was May 18, 2019, with no purported class members objecting or opting out. The deadline for purported class members to submit claims was August 1, 2019.

We are also currently responding to two government investigations related to the 2014 cyber-attack. The first is being conducted by various State Attorneys General, and the second is being conducted by the U.S. Department of Health and Human Services Office for Civil Rights. We are cooperating fully with both investigations.

Empire Health Foundation v. CHS/Community Health Systems, Inc., CHS Washington Holdings, LLC, Spokane Washington Hospital Company, LLC, Spokane Valley Washington Hospital Company, LLC.This suit was filed on June 12, 2017 by Empire Health Foundation claiming Deaconess and Valley Hospitals failed to abide by charity care obligations allegedly existing in the 2008 Asset Purchase Agreement between Empire Health System and Company affiliates. The court granted in part and denied in part the hospitals’ motion to dismiss on October 11, 2017. All parties filed motions for summary judgment, and the court granted in part and denied in part both parties’ motions on February 27, 2019 and July 9, 2019. The trial for this matter is set for August 12, 2019. We believe these claims are without merit and will vigorously defend the case.

Gibson, individually and on behalf of all others similarly situated v. National Healthcare of Leesville, Inc. d/b/a Byrd Regional Medical Center. This case is a purported class action lawsuit filed in the 30th Judicial District Court for the State of Louisiana and served on August 3, 2016, claiming our formerly affiliated Leesville, Louisiana hospital violated payor contracts by allegedly improperly asserting hospital liens against third-party tortfeasors and seeking class certifications for any similarly situated plaintiffs. The court has certified a class and denied our motion for summary judgment. We appealed both rulings to the Louisiana Third Circuit Court of Appeals, which affirmed the trial court’s decisions on March 7, 2019. We filed an application for writ of certiorari to the Louisiana Supreme Court, which was denied on May 29, 2019. WePlaintiff’s motion for approval of notice of class action was granted on October 24, 2019. As a result of the Louisiana Supreme Court’s decision in the combined cases of Matthew DePhillips v. Hospital Service District No. 1 of Tangipahoa Parish and Earnest Williams v. Hospital Service District No. 1 of Tangipahoa Parish, issued on July 9, 2020, holding that the proper statute of limitations and class period for claims like those in Gibson is one year rather than ten years, we believe these claims are without merit and will vigorously defend the case.potential liability in the Gibson case, if any, is not material.

Bowden, individually and on behalf of all others similarly situated v. Ruston Louisiana Hospital Company, LLC d/b/a Northern Louisiana Medical Center.This case is a purported class action lawsuit filed in the 3rd Judicial District Court for the State of Louisiana and served on September 7, 2016, claiming our affiliated Ruston, Louisiana hospital violated payor contracts by allegedly improperly asserting hospital liens against third-party tortfeasors and seeking class certifications for any similarly situated plaintiffs. Our motion for summary judgment is pending, as is plaintiff’s motion for class certification. Both motions are setAs a result of the Louisiana Supreme Court’s decision in the combined cases of Matthew DePhillips v. Hospital Service District No. 1 of Tangipahoa Parish and Earnest Williams v. Hospital Service District No. 1 of Tangipahoa Parish, issued on July 9, 2020, holding that the proper statute of limitations and class period for hearing on August 22, 2019. Weclaims like those in Bowden is one year rather than ten years, we believe these claims are without merit and will vigorously defend the case.

potential liability in the Bowden case, if any, is not material.

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Zwick Partners, LP and Aparna Rao, individually and on behalf of all others similarly situated v. Quorum Health Corporation, Community Health Systems, Inc., Wayne T. Smith, W. Larry Cash, Thomas D. Miller, and Michael J. Culotta. This purported class action lawsuit previously filed in the United States District Court, Middle District of Tennessee was amended on April 17, 2017 to include Community Health Systems, Inc., Wayne T. Smith and W. Larry Cash as additional defendants. The plaintiffs seek to represent a class of Quorum Health Corporation, or QHC, shareholders and allege that the failure to record a goodwill and long-lived asset impairment charge against QHC at the time of thespin-off of QHC violated federal securities laws. The District Court denied all defendants’ motions to dismiss on April 20, 2018. The plaintiffs moved for class certification. Plaintiffs also amended their complaint on September 14, 2018. We moved to dismiss the additional claims in the plaintiffs’ September 14, 2018 amended complaint and responded to plaintiffs’ class certification motion. On March 29, 2019, the court granted our motion to dismiss the additional claims. The court granted the plaintiffs’ motion for class certification on that same date. On April 12, 2019, we filed a petition for permission to appeal the court’s order granting class certification with the United States Court of Appeals for the Sixth Circuit, which was denied on July 31, 2019. On May 17, 2019, the plaintiffs moved to amend their complaint for a third time to add additional claims, which the District Court denied on August 2, 2019. We believeAll parties have now reached a tentative settlement of this case, and we are currently negotiating with plaintiffs on the claims are without merit and will vigorously defendfinal terms of the case.

R2 Investments v Quorum Health Corporation; Community Health Systems, Inc.; Wayne T. Smith; W. Larry Cash; Thomas D. Miller; Michael J. Culotta; John A. Clerico; James S. Ely, III; John A. Fry; William Norris Jennings; Julia B. North; H. Mitchell Watson, Jr.; H. James Williams. This case is pending insettlement to submit to the CircuitDistrict Court for Williamson County, Tennessee and was served on October 26, 2017. The plaintiff alleges common law fraud and violation of Tennessee securities fraud statutes in connection with its purchase of QHC stock and QHC senior secured notes. The court granted in part and denied in part the director defendants’ motion to dismiss and denied the remaining defendants’ motions to dismiss on May 11, 2018. We believe the claims are without merit and will vigorously defend the case.preliminary approval.

Steadfast Insurance Company, et al v. Community Health Systems, Inc., CHS/Community Health Systems, Inc., CHSPSC, LLC and Pecos Valley of New Mexico, LLC.LLC; Community Health Systems, Inc., et al v. Steadfast Insurance Company, et al; Anne Sperling, et al v. Community Insurance Group SPC, Ltd. These cases are filed in the Superior Court for the State of Delaware, the Chancery Court for the State of Delaware, and the First Judicial District Court for the State of New Mexico, respectively, and involve suits by three excess liability insurers seeking a declaration thatinsurance coverage disputes related to a $73 million judgment rendered against Pecos Valley of New Mexico, LLC inAnne Sperling, et al v. Pecos Valley of New Mexico, LLC (“Sperling I”). The first case was brought by Steadfast Insurance Company in Delaware Superior Court seeking a declaration that the Sperling I judgment is not a covered loss as defined by the insurance policies at issue.that are the subject of the case. The second case, filed by the Company in Delaware Chancery Court, seeks reformation of the subject policies. The third case (“Sperling II”), filed by the plaintiffs in Sperling I, seeks recovery from Pecos Valley of New Mexico, LLC’s insurers for the judgment awarded the plaintiffs in their separate, previous action against Pecos Valley of New Mexico, LLC. The Steadfast complaint was served on November 30, 2018. On December 13, 2018, Admiral Insurance Company, and Endurance Specialty Insurance Ltd, and Illinois Union Insurance Company moved to intervene in the suit as petitioners. CHS/The Company has initiated counterclaims against each insurer in that case, including for bad faith against Steadfast. The Company filed the Community Health Systems Inc. complaint on January 22, 2020. Sperling II was filed on July 24, 2019.  Plaintiffs amended their complaint to add Pecos Valley of New Mexico, LLC as a defendant in that action on May 21, 2020, and CHSPSC,Pecos Valley of New Mexico, LLC have moved to dismissfiled a third party action against certain insurer defendants in the petition filed by Steadfast Insurance Company.case on July 6, 2020. The judgment in Sperling I against Pecos Valley of New Mexico, LLC, which was rendered on September 5, 2018, in the First Judicial Court of the State of New Mexico, is currently on appeal to the Court of Appeals of the State of New Mexico. We believeConsolidated trial of theSteadfast and Community Health Systems, Inc. cases is set for July 26, 2021. The Company believes the insurers’ claims in the Steadfast, Community Health Systems, Inc. and Sperling II litigation are without merit and will vigorously defend and prosecute those cases.

Becky Kirk, Perry Ayoob, and Dawn Karzenoski, as representatives of a class of similarly situated persons, and on behalf of the CHS/Community Health Systems, Inc. Retirement Savings Plan v. Retirement Committee of CHS/Community Health Systems, Inc., John and Jane Does 1-20, Principal Life Insurance Company, Principal Management Corporation, and Principal Global Investors, LLC. This purported class action was filed in the United States District Court for the Middle District of Tennessee on August 8, 2019. The plaintiffs seek to represent a class of current and former participants in the CHS/Community Health Systems, Inc. Retirement Savings Plan and allege that the defendants breached their fiduciary duties by offering certain investments in the Plan that were more expensive and/or did not perform as well as other marketplace alternatives. We have reached a tentative, immaterial settlement with the plaintiffs and will be seeking court approval of the settlement.

Thomas Mason, MD, Steven Folstad, MD and Mid-Atlantic Emergency Medical Associates, PA v Health Management Associates, LLC f/k/a Health Management Associates, Inc., Mooresville Hospital Management Associates d/b/a Lake Norman Regional Medical Center and Statesville HMA, LLC d/b/a Davis Regional Medical Center, Envision Healthcare Corporation f/k/a Emergency Medical Services Corporation, Emcare Holdings, Inc., Emergency Medical Services, LP. This alleged wrongful retaliation case is filed in the United States District Court for the Western District of North Carolina. The plaintiffs allege their agreements with the defendants were terminated in retaliation for plaintiffs’ alleged refusal to admit patients unnecessarily to the defendant hospitals or otherwise perform unnecessary diagnostic testing. The allegations of the complaint relate to time periods prior to the hospitals’ affiliation with the Company. The plaintiffs filed a Third Amended Complaint on April 26, 2019. The defendants filed motions to dismiss, which were granted in part and denied in part on September 5, 2019. Trial of this matter is set for January 3, 2022. We believe these claims are without merit and will vigorously defend the case.

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Qui Tam Matters Where the Government Declined Intervention

U.S. and the State of Mississippi ex rel. W. Blake Vanderlan, M.D. v. Jackson HMA, LLC d/b/a Central Mississippi Medical Center and Merit Health Central.By order filed on August 31, 2017, the United States District Court for the Southern District of Mississippi ordered the unsealing of this qui tam suit. The unsealing revealed that on August 31, 2017 the United States had declined to intervene in the allegations that certain alleged EMTALA violations at the hospital resulted in a violation of the False Claims Act. Both the hospital and the United States have filed motions to dismiss the litigation, and those motions are pending. We believe this matter is without merit and will vigorously defend this case.

U.S. ex rel. Derek Lewis and Joey Neiman v. Community Health Systems, Inc., Medhost, Inc., et al. By order filed on March 14, 2019, the United States District Court for the Southern District of Florida ordered the unsealing of this qui tam suit. The order revealed that the United States had declined to intervene in the action. The complaint alleges that Community Health Systems, Inc. and its affiliated hospitals (CHS Hospitals) violated the False Claims Act by submitting claims for EHR Meaningful Use incentive payments that they knew or should have known were false. The allegations regarding falsity generally relate to the CHS Hospitals’ use of certain software products sold to them byco-defendant, Medhost, Inc. The plaintiffs amended their complaint on July 26, 2019. The defendants’ responseWe filed a motion to dismiss the amended complaint is dueon September 24, 2019. We believe this matter is without merit and will vigorously defend this case.

U.S. ex rel. Andrea Schultz v. Naples HMA, LLC (d/b/a Physicians Regional Healthcare System), Naples Heart Rhythm Specialists, P.A., and Dr. Kenneth Plunkitt. By order filed on April 1, 2019,On June 11, 2020, the United States District Court forgranted our motion to dismiss with prejudice. On July 13, 2020, we reached a non-monetary settlement with plaintiffs in which, among other things, they agreed not to appeal the Middle District of Florida ordered the unsealing of this qui tam suit. The order revealed that the United States had declined to intervene in the action. The complaint alleges the defendants violated the False Claims Act by submitting claims for payment related to certain procedures performed by defendant Dr. Kenneth Plunkitt at Physicians Regional Medical Center. Plaintiff voluntarily dismissed the hospital as a defendant from this case on May 31, 2019.

Court’s decision.

U.S. ex rel. Maur v. Elie Hage-Korban, M.D., Delta Clinics, PLC d/b/a The Heart and Vascular Center of West Tennessee. Community Health Systems, Inc., Knoxville HMA Holdings, LLC d/b/a/ Tennova Healthcare, Jackson Hospital Corporation d/b/a/ Regional Jackson, and Dyersburg Hospital Company, LLC, d/b/ Dyersburg Regional Medical Center. By order filed on April 30, 2019, the United States District Court for the Western District of Tennessee ordered the unsealing of this qui tam lawsuit. The order revealed that the United States had declined to intervene in the action. The complaint alleges the defendants violated the False Claims Act by submitting claims for payment related to certain cardiac procedures performed by defendant Dr. Elie Hage-Korban at two hospitals formerly affiliated with the Company. Dr. Hage-Korban was not employed by either hospital or their affiliates. The plaintiff amended his complaint on July 24, 2019. NoneWe filed a motion to dismiss the complaint on September 30, 2019, which the District Court granted on February 25, 2020. On March 18, 2020, the plaintiff filed a Notice of Appeal to the defendants have been served withUnited States Court of Appeals for the amended complaint.Sixth Circuit of all claims except those related to defendant Community Health Systems, Inc. That appeal is pending. We believe this matter is without merit and will vigorously defend this case.

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 our management, and all four members of the Audit and Compliance Committee are “audit committee financial experts” as defined in the Securities Exchange Act of 1934, as amended.

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, includingMS-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. The Board of Directors now oversees and reviews periodic reports of our compliance with the Corporate Integrity Agreement, or CIA, that we entered into with the United States Department of Health and Human Services Office of the Inspector General during 2014 and which was amended and extended in September 2018.

Item 1A.  Risk Factors

ThereThe following supplements the Company’s risk factors previously disclosed in the 2019 Form 10-K by including the following risk factors that take into account developments with respect to COVID-19 and the federal stimulus legislation specified below since the filing of the 2019 Form 10-K. Except as set forth below, there have been no material changes with regard to the risk factors previously disclosed in the 20182019 Form10-K.

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We expect the COVID-19 pandemic to materially affect our financial performance in 2020, and such pandemic may otherwise have material adverse effects on our results of operations, financial condition, and/or our cash flows.

COVID-19 was first identified in Wuhan, China in December 2019, and has spread throughout the world, including across the United States. In January 2020, the Secretary of HHS declared a national public health emergency due to the novel coronavirus. In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In an attempt to contain the spread and impact of COVID-19, authorities throughout the United States and the world have implemented measures such as travel bans and restrictions, quarantines, stay-at-home and shelter-in-place orders, the promotion of social distancing, and limitations on business activity. This pandemic has resulted in a significant economic downturn in the United States and globally, and has also led to significant disruptions and volatility in capital and financial markets.

As a provider of healthcare services, we are significantly exposed to the public health and economic effects of the COVID-19 pandemic. We have been working with federal, state and local health authorities to respond to COVID-19 cases in the communities we serve and have been taking or supporting measures to try to limit the spread of the virus and to mitigate the burden on the healthcare system, including rescheduling or cancelling elective procedures at our hospitals and other healthcare facilities. In addition, some states have been requiring hospitals to maintain a reserve of personal protective equipment and mandating COVID-19 screening for new patients and certain hospital staff.

Beginning in March 2020, we experienced a substantial reduction in the number of elective surgeries, physician office visits and emergency room volumes at our hospitals and other healthcare facilities due to restrictions on elective procedures, quarantines, stay-at-home and shelter-in-place orders, the promotion of social distancing, as well as general concerns related to the risk of contracting COVID-19 from interacting with the healthcare system. Given the general necessity of the healthcare services we provide, we anticipate that in the future historically normal service levels may resume and that the deferral of services during the pandemic may create a backlog of demand; however, there is no assurance that either will occur and, to the extent this occurs, when this will occur.

In addition, while our hospitals have not experienced major capacity constraints to date arising from the treatment of COVID-19 patients, there are hospitals in the United States that are located in centers of the COVID-19 outbreak and have been overwhelmed in caring for COVID-19 patients, which has prevented such hospitals from treating all patients who seek care. Our hospitals could be subject to such conditions in the future if a major COVID-19 outbreak occurs in a geographic region where any of our hospitals are located. In addition, some states have been limiting hospital volume by requiring a minimum percentage of vacant beds in case of a surge in COVID-19 patients.

We may also experience supply chain disruptions as the result of the COVID-19 pandemic, including shortages, delays and price increases in equipment, pharmaceuticals and medical supplies. Staffing, equipment, and pharmaceutical and medical supplies shortages may also impact our ability to admit and treat patients. We have also incurred, and may continue to incur, certain increased expenses arising from the COVID-19 pandemic, including additional supply chain and other expenditures.

We have been implementing considerable safety measures at our hospitals and healthcare facilities, and we have instituted a work-from-home policy for certain of our corporate and administrative offices. Nevertheless, exposure to COVID-19 patients has increased risks to our physicians, nurses and other medical staff, which may further reduce our operating capacity. All of these developments could result in reduced employee morale, labor unrest, work stoppages or other workforce disruptions.  

Broad economic factors resulting from the current COVID-19 pandemic, including increased unemployment and underemployment levels and reduced consumer spending and confidence, may also adversely affect our service mix, revenue mix, payor mix and patient volumes, as well as our ability to collect outstanding receivables. Business closures and layoffs in the geographic areas in which we operate have led to increases in the uninsured and underinsured populations, which may continue to adversely affect demand for our services, as well as the ability of patients and other payors to pay for services rendered. Any material increase in the amount or deterioration in the collectability of patient accounts receivable may adversely affect our financial results, and require an increased level of working capital. In addition, our financial performance continues to be adversely affected, by federal or state laws, regulations, orders, or other governmental or regulatory actions addressing the current COVID-19 pandemic or the U.S. healthcare system, which have resulted in and may continue to result in direct or indirect restrictions with respect to our business. We may also be subject to lawsuits from patients, employees and others exposed to COVID-19 at our facilities. Such actions may involve large demands, as well as substantial defense costs. Our professional and general liability insurance may not cover all claims against us.

60


We are not able to fully quantify the impact that the COVID-19 pandemic will have on our financial results during 2020, but expect developments related to COVID-19 to materially affect our financial performance in 2020. Moreover, the COVID-19 pandemic may have material adverse effects on our results of operations, financial position, and/or our cash flows. The ultimate impact of the pandemic on our financial results will depend on, among other factors, the duration and severity of the pandemic and negative economic conditions arising from the pandemic, the volume of canceled or rescheduled procedures at our facilities, the volume of COVID-19 patients cared for across our health systems, the timing and availability of effective medical treatments and vaccines, and the impact of government actions and administrative regulation on the hospital industry and broader economy, including through existing and any future stimulus efforts. COVID-19 developments continue to evolve quickly, and additional developments may occur which we are unable to predict. Furthermore, the COVID-19 pandemic has resulted in, and may continue to result in, significant disruption of global financial markets, which could reduce our ability to access capital and negatively affect our liquidity in the future. Finally, the pandemic could heighten the level of risk in certain of the other risk factors described in the 2019 Form 10-K, any of which could have a material effect on us.

There is a high degree of uncertainty regarding the implementation and impact of the CARES Act and the PPPHCE Act. There can be no assurance as to the total amount and types of assistance we will receive or that we will be able to benefit from provisions intended to increase access resources and ease regulatory burdens for healthcare providers.

The CARES Act is a $2 trillion economic stimulus package signed into law on March 27, 2020, in response to the COVID-19 pandemic. The PPPHCE Act, an expansion of the CARES Act that includes additional emergency appropriations, was signed into law on April 24, 2020. Together, the CARES Act and PPPHCE Act authorize $175 billion in funding to be distributed to hospitals and other healthcare providers through the PHSSEF. These funds are intended to reimburse eligible providers, including public entities and Medicare- and/or Medicaid-enrolled providers and suppliers, lost revenues and incremental expenses attributable to the COVID-19 pandemic. Recipients are not required to repay these funds, provided that they attest to and comply with certain terms and conditions, including limitations on balance billing, not using funds received from the PHSSEF to reimburse expenses or losses that other sources are obligated to reimburse and audit and reporting requirements. As noted above, HHS has paid or allocated a portion of the total PHSSEF funding, but has not yet announced the precise method by which all future payments from the PHSSEF will be determined or allocated.  Moreover, while we have received payments from the initial funding of the PHSSEF as described above, the amount of future payments from the PHSSEF to the Company is not currently known.

The CARES Act also makes other forms of financial assistance available to healthcare providers, including through Medicare and Medicaid payments adjustments and an expansion of the Medicare Accelerated and Advance Payment Program, which makes available accelerated payments of Medicare funds in order to increase cash flow to providers. As noted above, we have received accelerated payments under this program. However, CMS is reevaluating new applications from Medicare Part A providers, including hospitals, for accelerated payments in light of direct payments made available through PHSSEF and has suspended the advance payment program for physicians and other Medicare Part B providers.

In addition to financial assistance, the CARES Act includes provisions intended to increase access to medical supplies and equipment and ease legal and regulatory burdens on healthcare providers. For example, the CARES Act suspends the Medicare sequestration payment adjustment from May 1, 2020 through December 31, 2020 (but extends sequestration through 2030), provides for a 20% add-on payment under the hospital inpatient PPS for care provided to patients with COVID-19, expands access to and payment for telehealth services under Medicare, prioritizes review of drug applications to help with shortages of emergency drugs, and delays Medicaid DSH reductions.

Due to the recent enactment of the CARES Act, the PPPHCE Act and other enacted legislation, there is still a high degree of uncertainty surrounding the implementation of such legislation. Some of the measures allowing for flexibility in delivery of care and various financial supports for health care providers are available only for the duration of the public health emergency, and it is unclear whether or for how long the HHS declaration will be extended. The current declaration expires October 23, 2020. The HHS Secretary may choose to renew the declaration for successive 90-day periods for as long as the emergency continues to exist and may terminate the declaration whenever he determines that the public health emergency no longer exists. There can be no assurance as to the total amount of financial and other types of assistance we will receive under the CARES Act and the PPPHCE Act, and it is difficult to predict the impact of such legislation on our operations or how they will affect operations of our competitors. Additionally, the federal government may consider additional stimulus and relief efforts, but we are unable to predict whether any additional stimulus measures will be enacted or their impact. We are unable to assess the extent to which anticipated negative impacts on us arising from the COVID-19 pandemic will be offset by amounts or benefits received under the CARES Act, or amounts or benefits which we may in the future receive under the CARES Act and the PPPHCE Act, as well as any future federal stimulus measures. Further, there can be no assurance that the terms of provider relief funding or other programs will not change in ways that affect our funding or eligibility to participate. We continue to assess the potential impact of the COVID-19 pandemic and government responses to the pandemic on our business, results of operations, financial position and cash flows.

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Item 2.  Unregistered Sale of Equity Securities and Use of Proceeds

The following table contains information about our purchases of common stock during the three months ended June 30, 2019.2020.

 

Period

  Total Number of Shares
Purchased (a)
          Average Price Paid per    
Share
   Total Number of Shares
Purchased as Part of Publicly
Announced Plans or
Programs (b)
   Maximum Number of Shares
That May Yet Be Purchased
Under the Plans or Programs
(b)
 

April 1, 2019 -

         

April 30, 2019

   -     $    -      -      -   

May 1, 2019 -

         

May 31, 2019

   -       -      -      -   

June 1, 2019 -

         

June 30, 2019

   43,696       2.66      -      -   
  

 

 

      

 

 

   

Total

   43,696     $    2.66      -      -   
  

 

 

      

 

 

   

Period

 

Total

Number

of Shares

Purchased (a)

 

 

Average

Price

Paid per

Share

 

 

Total

Number

of Shares

Purchased as

Part of

Publicly

Announced

Plans or

Programs (b)

 

 

Maximum

Number of

Shares That

May Yet Be

Purchased

Under the

Plans or

Programs (b)

 

April 1, 2020 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April 30, 2020

 

 

7,517

 

 

$

3.63

 

 

 

 

 

 

 

May 1, 2020 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May 31, 2020

 

 

 

 

 

 

 

 

 

 

 

 

June 1, 2020 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June 30, 2020

 

 

19,734

 

 

 

3.19

 

 

 

 

 

 

 

Total

 

 

27,251

 

 

$

3.31

 

 

 

 

 

 

 

 

(a)

43,69627,251 shares were withheld to satisfy the payment of tax obligations related to the vesting of restricted stock awards.

(b)

We had no publicly announced plans or open market repurchase programs for shares of our common stock during the sixthree months ended June 30, 2019.2020.

With the exception of a special cash dividend of $0.25 per share paid by us in December 2012, historically, we have not paid any cash dividends. Subject to certain exceptions, our CreditThe ABL Facility limitsand the ability of our subsidiaries to pay dividends and make distributions to us, and limits our ability to pay dividends and/or repurchase stock, to an amount not to exceed $100 million in the aggregate, subject to certain restrictions. The indentures governing each series of our outstanding notes also restrict our subsidiaries from, among other matters, paying dividends and making distributions to us, which thereby limits our ability to pay dividends and/or repurchase stock. As of June 30, 2019,2020, under the most restrictive test in these agreements (and subject to certain exceptions), we have approximately $100$200 million available with whichof capacity to pay permitted dividends and/or repurchase shares of our stock or make other restricted payments.

Item 3.  Defaults Upon Senior Securities

None.

Item 4.MineMine Safety Disclosures

Not applicable.

Item 5.OtherInformation

None.

62


Item 6.Exhibits

 

No.

Description

31.1

10.1

*

Community Health Systems, Inc. 2009 Stock Option and Award Plan, as amended and restated as of March 20, 2020 (incorporated by reference to Exhibit 10.1 to Community Health Systems, Inc.’s Current Report on Form 8-K filed May 13, 2020 (No. 001-15925)).

22.1

*

List of Subsidiary Guarantors and Issuers of Guaranteed Securities

31.1

*

Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2

31.2

*

*

Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1

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

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

*

The following financial information from our quarterly report on Form 10-Q for the quarters and six months ended June 30, 2020 and 2019, filed with the SEC on July 29, 2020, formatted in Inline Extensible Business Reporting Language: (i) the condensed consolidated statements of income (loss) for the three and six months ended June 30, 2020 and June 30, 2019, (ii) the condensed consolidated statements of comprehensive income (loss) for the three and six months ended June 30, 2020 and June 30, 2019, (iii) the condensed consolidated balance sheets at June 30, 2020 and December 31, 2019, (iv) the condensed consolidated statements of cash flows for the three and six months ended June 30, 2020 and June 30, 2019, and (v) the notes to the condensed consolidated financial statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.

101.INS

104

*

Cover Page Interactive Data File (formatted as Inline 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 Linkbaseand contained in Exhibit 101).

 

*

Filed herewith.

**

Furnished herewithherewith.

Indicates a management contract or compensatory plan or arrangement.

63


SIGNATURES

Pursuant to the requirements of section 13 or 15(d) 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:

By:

/s/   Wayne T. Smith

Wayne T. Smith

Chairman of the Board and

Chief Executive Officer

(principal executive officer)
By:

/s/    Thomas J. Aaron

 

Thomas J. Aaron

Executive Vice President and
Chief Financial Officer
(principal financial officer)

By:

/s/   Kevin J. Hammons

Kevin J. Hammons

Executive Vice President and

Chief Financial Officer

By:

/s/   Jason K. Johnson

Jason K. Johnson

Senior Vice President Assistant Chief Financialand

Officer,

Chief Accounting Officer and Treasurer

(principal accounting officer)

Date:  August 6, 2019July 29, 2020

 

64

86