The announcement was made Tuesday, just five months after Community Health Systems bought Forum Health, and it emerged from bankruptcy. "Eliminating jobs is very difficult," said David Fikse, Northside Medical Center and Health System CEO, in a release. "We know this decision has a real and direct impact on the lives of those affected. At the same time, we must make these adjustments in order to restore and strengthen our hospitals so that we may remain open and ready to care for our patients and to provide jobs for local residents." He goes on to say that the hospitals have been through challenging times, and as they continue to grow while the economy recovers, they hope to add jobs again.

Much of what CHS has purchased since October for the hospitals and satellite operations, such as its medical parks in Austintown and on Elm Road, isn't "sexy [but] they're things that were very necessary for patient care and for the ability of our physicians and nurses to take care of the patients," he said. That capital spending -- part of the $80 million that CHS had pledged for upgrades over the next five years before it closed the purchase -- has ranged from replacing most of the patient beds and all of the intravenous pumps in the hospitals to changing all of the furniture and converting all of the television sets to flat screens in patient rooms, Fikse reported. Other funds have been spent on new ventilators and anesthesia machines in the operating rooms.

All three agreements contain wage freezes for the length of the contracts, which extend the current pacts by two years, incorporates the hospitalization plan proposed by Ardent Health Services Inc., which had sought to purchase Forum, and provides a 401(k) contribution match, Connelly said.

The AFSCME agreement is "an amalgam" between the contract that had been negotiated with Ardent Health Services Inc. of Nashville, Tenn., which had earlier reached a deal to acquire Forum's assets, and the current pact with Forum, said Tom Connelly, president of AFSCME/United Nurses Association Local 2026, which represents registered nurses at Trumbull. The tentative agreement is "concessionary" but the concessions aren't as extensive as in the agreement negotiated with Ardent, Connelly said. "We're pleased with it, actually," he remarked.

The attorney general said his office's review found that CHS was making a "significant commitment to the future" of the three hospitals that are now part of Forum, pledging a minimum of $80 million to renovate and upgrade its facilities, and adopting an indigent care policy to provide free or discounted care and to participate in Medicare and Medicaid for at least the next five years. The review also found "no apparent conflicts of interest or breaches of fiduciary duty," he said. "The purchase price of $120 million is sufficed to pay the secured creditors, which means that the foundation assets will not be touched," he added, which had been a concern for many in the community. The bid was nearly double that of the $69.8 million sale price initially offered by Ardent Health Services of Nashville, Tenn., he said.

Although Cordray has repeatedly said that federal bankruptcy law "explicitly" recognizes, respects and accommodates the state's role in reviewing the sale, it is unclear what impact, if any, a negative recommendation would have on the process.