Significant scale (about $19 billion annual revenues), making it the second largest for-profit rated hospital next to Hospital Corporation of America Inc; Relatively diversified hospital portfolio; Good position in its relatively small markets; Negative operating trends, such as weak patient volume and declining profitability; and Subject to potential reduction in government reimbursement. High debt burden; and Sufficient cash generation to fund all capital expenses, with estimated free operating cash flow (FOCF) generation of about $500 million annually. Our base-case scenario anticipates weak patient volume and declining profitability (stemming from the Health Management Associates [HMA] acquisition) in the near term. Our negative outlook reflects the company's failure to achieve the expected acquisition-related benefits, improve EBITDA margins, and reduce debt leverage. We
