The speculative-grade ratings on Brentwood, Tenn.-based Community Health Systems Inc. reflect Standard&Poor's Ratings Services' concern about the company's aggressive acquisition activity and the uncertain future reimbursement levels it will receive from the government and other third-party payors. The company's total debt outstanding as of March 31, 2005 was $1.8 billion. Community Health, operating 68 hospitals in 21 states, primarily in small, non-urban markets with stable or growing populations, has seen its revenues double since 2001. The company acquires weak, underperforming hospitals and attempts to build revenues by enhancing physician recruitment and broadening services. Community Health is expected to continue to expand, adding about two to four hospitals per year. Ongoing acquisitions could create integration challenges that make it
