The health care industry is highly competitive. In recent years, competition among healthcare providers for patients has intensied in the country due to, among other things, regulatory and technological changes, increasing use of managed care payment systems, cost containment pressures and a shift toward outpatient treatment. In all of the geographical areas in which we operate, there are other hospitals that provide services comparable to those offered by our hospitals. In addition, some of our competitors include hospitals that are owned by tax-supported gov-ernmental agencies or by non prot corporations and may be supported by endowments and charitable contributions and exempt from property, sale and income taxes. Such exemptions and support
