PHOTO BY KRISTINE GILL. A small group of registered nurses gathered Wednesday, Jan. 8, 2013 outside the Tiburon Country Club to protest a multi-billion dollar hospital merger.

Shareholders in a Naples-based hospital operator have overwhelmingly approved the sale of the company to Community Health Systems Inc.

Nearly 98 percent of the votes cast by shareholders in Health Management Associates Inc. at a special meeting today were in favor of adopting the merger agreement.

A 70 percent vote was required. Shareholders holding 81.7 percent of HMA's outstanding common shares voted for the acquisition.

In a statement, Wayne T. Smith, board chairman, president and CEO of Community Health Systems, said, "We are pleased that HMA stockholders have seen the significant strategic value in combining with CHS. We are working now to finalize regulatory approvals, and we expect to complete this transaction quickly so that we can integrate our two companies and deliver on our plans for long-term growth and value creation."

The transaction is expected to closed by the end of January.

EARLIER

A small but widely representative group of registered nurses gathered Wednesday morning outside the Tiburon Golf Club in North Naples to protest a multibillion dollar hospital merger.

Inside the club, shareholders from Community Health Systems and Health Management Associates were to discuss Tennessee-based CHS's offer to buy Naples-based HMA, which operates two Physicians Regional hospitals and other hospitals in the U.S.

"Our concern, No. 1, is that CHS operates six of the nine most expensive hospitals in this country," said Steve Matthews, a labor representative for the National Nurses Organizing Committee.

About 10 people from California, Pennsylvania and West Virginia met near the intersection of Tiburon Boulevard amid a light drizzle, hours before each was to board their respective flights home.

Veronica Poss, a registered nurse working at a CHS-owned hospital in Fallbrook, Calif., said the decision will negatively impact patient care at her hospital and locally.

"They're cutting corners to get this money and do this," she said.

A 75-patient cardiac rehab center at her hospital which she said costs $110,000 a year to run was shut down through a CHS decision this year, a casualty, she believes, of the group's attempts to monopolize patient care in small communities where other options are not within reasonable distance.

"I'm just trying to be an advocate and let everybody know," she said.

The group was to disband by 10 a.m. but their fight with CHS would not be over, regardless of the decision made Wednesday.

"It's a different day, same story for me," said Tim Thomas, a registered nurse at a CHS facility in Watsonville, Calif. where he is currently involved in contract negotiations with the union there.