Summary of COMMUNITY HEALTH SYSTEMS INC

Item 2. Management's Discussion and Analysis of Financial Condition and Results
of Operations
You should read this discussion together with our unaudited condensed consolidated financial statements and accompanying notes included herein.
Throughout this Quarterly Report on Form 10-Q, Community Health Systems, Inc., the parent company, and its consolidated subsidiaries are referred to on a collective basis using words like "we," "our," "us" and the "Company". This drafting style is not meant to indicate that the publicly-traded parent company or any 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, and management services provided, by distinct and indirect subsidiaries of Community Health Systems, Inc. References to the Company may include one or more of its subsidiaries. Executive Overview
We are the largest publicly traded operator of hospitals in the United States in terms of number of facilities and net operating revenues. We provide healthcare services through these hospitals that we own and operate in non-urban and selected urban markets. We generate revenue primarily by providing a broad range of general hospital healthcare services to patients in the communities in which we are located. We currently have 122 general acute care hospitals. In addition, we own and operate home care agencies, located primarily in markets where we also operate a hospital, and through our wholly-owned subsidiary, Quorum Health Resources, LLC, or QHR, we provide management and consulting services to non-affiliated general acute care hospitals located throughout the United States. We are paid for our services by governmental agencies, private insurers and directly by the patients we serve.
Despite the current economic environment, in which signs of a recovery from the recession are tempered by a continuing rise in unemployment, our net operating revenue for the three months ended September 30, 2009 increased to $3.087 billion, as compared to $2.755 billion for the three months ended September 30, 2008. Income from continuing operations, before noncontrolling interests, for the three months ended September 30, 2009 increased 27.5% over the three months ended September 30, 2008. This increase in income from continuing operations during the three months ended September 30, 2009, as compared to the three months ended September 30, 2008, is due primarily to an increase in surgeries performed at our hospitals, strong outpatient growth, the realization of synergies from our acquisition of Triad Hospitals, Inc., or Triad, and the recognition of cost savings from our ability to effectively control costs. Our successful physician recruiting efforts have also been a key driver in the execution of our operating strategies. Total inpatient admissions for the three months ended September 30, 2009 increased 7.2% compared to the three months ended September 30, 2008 and adjusted admissions for the three months ended September 30, 2009 increased 9.0% compared to the three months ended September 30, 2008. This increase in inpatient and adjusted admissions was due primarily to our recent acquisitions.
Our net operating revenue for the nine months ended September 30, 2009 increased to $9.016 billion, as compared to $8.138 billion for the nine months ended September 30, 2008. Income from continuing operations, before noncontrolling interests, for the nine months ended September 30, 2009 increased 28.5% over the nine months ended September 30, 2008. This increase in income from continuing operations during the nine months ended September 30, 2009, as compared to the nine months ended September 30, 2008 is primarily the result of contributions from recent acquisitions, along with an increase in surgeries performed at our hospitals, strong outpatient growth, the realization of synergies from the Triad acquisition, and the recognition of cost savings from our ability to effectively control costs. Inpatient admissions for the nine months ended September 30, 2009 increased 3.5% compared to the nine months ended September 30, 2008 and adjusted admissions for the nine months ended September 30, 2009 increased 5.5% compared to the nine months ended September 30, 2008. This increase in both inpatient and adjusted admissions was due primarily to our recent acquisitions.
Self-pay revenues represented approximately 11.4% and 11.1% of our net operating revenues for the three months ended September 30, 2009 and 2008, respectively, and 11.2% and 10.9% of our net operating revenues for the nine months ended September 30, 2009 and 2008, respectively. The value of charity care services relative to total net operating revenues increased to 4.0% and 3.8% for the three and nine months ended September 30, 2009, respectively, from 3.3% and 3.6% for the three and nine months ended September 30, 2008, respectively. Uninsured and underinsured patients continue to be an industry-wide issue, and we anticipate this trend will continue into the foreseeable future. Legislative reform impacting the healthcare industry remains a priority of the current presidential administration and various proposals continue to be strongly debated in Congress. Given the current level of uncertainty of what may result from these reform proposals, it is not possible, at this time, to accurately predict what impact any final legislation may have on us.

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As a result of our current levels of cash, available borrowing capacity, long-term outlook on our debt repayments and our continued projection of our ability to generate cash flows, we do not anticipate a significant impact on our ability to invest the necessary capital in our business over the next twelve months and into the foreseeable future. We believe there continues to be ample opportunity for growth in substantially all of our markets by decreasing the need for patients to travel outside their communities for health care services. Furthermore, we continue to benefit from synergies from the acquisition of Triad as well as our more recent acquisitions and will continue to strive to improve operating efficiencies and procedures in order to improve our profitability at all of our hospitals.
During the three months ended June 30, 2009, we decided to retain a hospital and related businesses previously classified as held for sale. Results of operations for all periods presented have been restated to include this retained hospital and related businesses, which previously were reported as discontinued operations. The condensed consolidated balance sheets for each of the periods presented have been restated to present the assets and liabilities previously reported as held for sale in the applicable financial statement line items. Sources of Consolidated Net Operating Revenue The following table presents the approximate percentages of net operating revenue derived from Medicare, Medicaid, managed care, self-pay and other sources for the periods indicated. The data for the periods presented are not strictly comparable due to the significant effect that hospital acquisitions have had on these statistics.