Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Pitching Chicago to China

World Business Chicago Vice Chairman Michael Sacks and former Commerce Secretary William Daley leave Sunday on a six-day business mission to China, Sacks' first official foreign trip as a top adviser to Mayor Rahm Emanuel.

Sacks said that he and Daley will pay their own way to China while World Business Chicago, a nonprofit that acts as the city's economic development agency, will cover the travel costs for two staff members, including one from the mayor's office.

Sacks and Daley will visit Hong Kong and Beijing before joining up with Choose Chicago CEO Don Welsh and the Chicago Symphony Orchestra in Shanghai.

There, they'll take in a CSO concert and co-host a reception for about 75 people, including tour operators, and China-based alumni of Northwestern University's Kellogg School of Management and the University of Chicago's Booth School of Business.

Sacks said he asked for Daley's help in selling Chicago to foreign officials, specifically the Chinese, after the former chief of staff to President Barack Obama returned home from Washington last year. Sacks said that was months before Daley said he was considering a run for governor in 2014.

"His gravitas, his stature as former commerce secretary and former chief of staff have made the quality of this trip better than anything I could have done myself," Sacks said. "I would not have been able to secure these meetings without him."

Daley and Sacks are expected to meet with 30-plus corporate executives, including the CEO of Hong Kong-based airline Cathay Pacific and billionaire Chinese entrepreneur Lu Guanqiu, whose son-in-law, Pin Ni, runs Elgin-based auto parts maker Wanxiang America Corp.; six Chinese officials, including the acting mayor of Beijing and China's commerce minister, Chen Deming; and U.S. Ambassador to China Gary Locke.

Sacks' role with World Business Chicago is a volunteer position. His day job is CEO of Grosvenor Capital Management. The investment firm is known as a hedge fund of funds because its primary business is to invest in multiple hedge funds on behalf of large investors, such as pension funds, corporations and sovereign wealth funds.

Sacks frequently travels abroad for his work, often adding city-related sales pitches to his itineraries. This, however, is his first foreign trip focused on his work at World Business Chicago.

Spertus changes name

The Spertus Institute this week will tweak its name — and with it, its identity — as part of an ongoing effort to recover from an unfortunately timed decision to open a new building on the eve of the financial crisis.

The institute, which has been a pillar of Jewish culture in Chicago since 1924, will now be called the Spertus Institute for Jewish Learning and Leadership. The institute also announced that its programming for children and families will be cut for the foreseeable future in favor of new academic offerings for people working at nonprofits.

"During the past 31/2 years, we eliminated a $3.8 million operating deficit, largely by dramatically reducing our programmatic footprint," said Hal Lewis, the institute's president, who took over in July 2009. "So I didn't have the money to go and get branding assistance. But I was convinced we had a branding challenge — because when I first became president I spent a good solid four months on a listening tour, in which people told me, 'Oh, yeah, I know something about Spertus,' but there was uncertainty about the work we did."

A grant from the Harvey L. Miller Foundation paid for most of the rebranding effort, which an outside consulting firm led.

"I should say I'm generally skeptical of consultants," Lewis said. "But they taught me something elegantly simple: Spend more time talking about the why and less time on the how. We know the enormous array of programs we offer ... but we never said why that's important. ... (The answer is) we believe that a learning Jewish community is a vibrant Jewish community. It is the historic experience of the Jewish people that learning doesn't stop at adolescence."

The institute has about 400 students in degree and certificate programs, from a one-day certificate in grant writing to a doctorate in Jewish studies, which can take up to 10 years to complete. The institute also offers public lectures on politics, arts and culture as well as museum-style exhibits.

Spertus plans to offer new leadership concentrations within its master's degree programs aimed at youth workers, camp counselors and early childhood teachers. It also plans to create programs in social entrepreneurship and lay-leader training. Lewis said also he may eliminate one of Spertus' existing education degrees, but these changes are not final and will not be announced until the spring.

"We were never best at early childhood education," Lewis said. "The synagogues are far better at that ... So this is not a retreat from one of our historic strong suits."

The seeds of the long-running overhaul of Spertus can be traced to the November 2007 opening of its building, an iconic glass sculpture at 610 S. Michigan Ave.

Lewis said so many assumptions about the building failed to materialize, such as revenue from room rentals. Nonprofits also heavily cut professional development funds during the recession, which, in turn, lowered enrollment because students were no longer able to get help paying for their master's degrees.

However, rentals and other economic indicators are beginning to reverse. The falling stock market hurt Spertus' program endowment, slicing it to about $6 million, and its building endowment to about $12 million. Those funds are now at about $7 million and about $17 million, respectively, Lewis said.

Steven Nasatir, president of the Jewish United Fund/Jewish Federation of Metropolitan Chicago, said his organization is assisting Spertus with fundraising. He said without the branding and other program changes Lewis is making, Spertus would be "treading water."

"The name change is a manifestation of resetting goals and is a positive thing," he said. "People have to better understand what you're attempting to do."

Melissa Harris can be reached at mmharris@tribune.com or 312-222-4582.

Twitter @chiconfidential

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Terrorists Knocked Off Twitter After Threats

The Twitter account belonging to a self-identified spokesperson for an al Qaeda-allied terrorist organization has been suspended.

The account, which began in late 2011 and is believed to belong to a representative of al-Shabaab, a Somalia-based terrorist organization, is currently out of service, days after it threatened the lives of Kenyan hostages, according to a report by The Associated Press.

Representatives for Twitter declined to comment on exactly when or why al-Shabaab’s account was suspended, due to “privacy and security reasons,” but under “Twitter Rules,” the company writes on its website that “you may not publish or post direct, specific threats of violence against others.”

In addition to the reported threats against the Kenyans, earlier this month the same account posted a long missive about France’s failed attempt to rescue a French intelligence agent codenamed Denis Allex and posted images of another man it said was a French special operations soldier who was killed in the doomed raid. The statement said the group had reached a “verdict” on what to do about Allex and, a few days later, al-Shabaab said they planned to execute the spy. Then, using Twitter, they announced Allex was dead.

READ: Terrorists Say They’ll ‘Execute’ Spy Who May Already Be Dead

The account, along with those of other terrorist organizations, for years has provided a window, tinted by propaganda, into the group, its ambitions and inner troubles – a resource for journalists and, presumably, interested intelligence agencies.

For instance, in March 2012, Twitter was the forum al-Shabaab used to deny it had arrested or was trying to kill its most high-profile member, Omar Hammami, a rapping American jihadist who goes by the nom de guerre Abu Mansoor al-Amriki. Hammami had taken to the internet to describe, in detail, a fissure within the terror group. He may himself be operating another Twitter account with which he engages in long exchanges about the state of jihadism in Somalia.

In September 2011, ABC News reported on a curious public spat that emerged between NATO forces and the Taliban – all over Twitter. Lebanon-based Hezbollah, considered a terrorist organization by the U.S. government, also has a media arm that Tweets frequently.

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Lena Dunham says “Girls” season 3 starts shooting in March

LOS ANGELES (TheWrap.com) – HBO has yet to announce whether “Girls” has been renewed for a third season, but that’s okay, because Lena Dunham may have done it for them.

The writer, director and star of the critically-acclaimed comedy told Alec Baldwin during his WNYC podcast, “Here’s the Thing,” that she is preparing to start shooting the next season in March.

“I just finished season two,” the Golden Globe-winning actress said on Monday. “We’re starting at the end of March. I’m so excited.”

And much to delight of million of the 1.6 total overall viewers that tuned in to watch three airings of the premiere on January 13, Dunham says the episode order may have been increased from 10 to 12.

“Well, we’ve been doing 10,” she continued. “I think between you, me and McGee, I think we might do 12 next year.”

HBO wouldn’t officially confirm the renewal to TheWrap, but Dunham’s interview makes it sound like she will call the premium cable network home for years to come. She admits it’s “not clear” how many seasons of “Girls” she is contractually obligated to continue writing and directing, but says she’s locked in as an actor for six years.

“HBO contractually has me I think as an actor for six years but as a writer and director – I should pay more attention to my deals, but I’m just so excited to have my job,” she said. “I just go, ‘Okay, whatever you say.’”

Another thing she should start getting excited about is the possibility of not just talking to Baldwin – one of her idols – but working with him, too.

After she revealed a third season, the “30 Rock” star was quick to add: “I’ll be available. I’ll come and play your therapist.”

“That would be the most fun thing in the world,” she responded before later adding: “Working with you is one of my longstanding dreams.”

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40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

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2012 stock report: Pains and gains

If you invested heavily in Illinois companies that provide consulting services, you had little reason to celebrate in 2012.

While the Standard & Poor's 500 index ended the year up 13 percent, most large businesses in the region that counsel other companies on how to improve their operations saw their stock prices drop.

Business support services was one of the few sectors getting clobbered in a 2012 Tribune ranking of Illinois and northwest Indiana stocks' performance.

Stock prices gained at about 70 percent of the 127 companies on the list, and about half outperformed the S&P 500. Bank owners such as Taylor Capital Group emerged from their 2011 doldrums, and Ulta Salon Cosmetics & Fragrance Inc. and Discover Financial Services marked their second consecutive year of soaring stock prices.

The year's biggest decliner, down 76 percent, was Groupon, as once-torrid revenue growth at the daily deals offerer started slowing.

Career Education was the second-worst performer; its stock fell 56 percent. The highly scrutinized for-profit school chain said it would close campuses and cut jobs amid sinking revenue and financial losses.

Sectors boosted by broad gains in 2012 included electrical parts and equipment, industrial machinery, and specialty chemicals.

Of seven Illinois banks on the list, all but one outperformed the S&P 500, with price appreciation of those six ranging from 16 to 86 percent.

In contrast, stocks of four of five professional services firms — Navigant Consulting, Huron Consulting Group, Heidrick & Struggles International and R.R. Donnelley & Sons — closed down 2 to 38 percent.

Each had its own set of issues.

Navigant's services, for example, include advising companies that face disputes, litigation and investigations, including government probes, as well as businesses that need help valuing potential mergers and acquisitions.

"You see fewer government investigations during an election year, as regulators are leaving their jobs, and they don't want to start new ones," said Tobey Sommer, a SunTrust Robinson Humphrey analyst. "Also, worries about the 'fiscal cliff' slowed M&A because CEOs didn't want to look foolish acquiring a company in September ahead of the fiscal cliff when they might have been able to buy it for 20 percent less in January had we gone off."

Meanwhile, Heidrick's troubles included a slowing market for executive searches. In early 2012, analysts expected Heidrick's annual earnings to be in the range of about $1.30 per share. It appears that it will earn closer to 57 cents a share.

Huron's earnings estimates during 2012 were also trimmed, to about $2.10 from about $2.40 a share as the timing of fee payments to its health care consulting business proved volatile.

"Its underlying demand is strong," but an increasing number of clients had signed contracts where a larger portion of revenue was contingent on the outcome of Huron's consulting work, said Randle Reece, analyst with Avondale Partners LLC. That made it harder for the company and the analysts who cover it to predict the timing of revenues, since they are deferred.

For investors interested in "Dumpster diving," Morningstar Inc. considers Exelon, WMS Industries and Caterpillar to be high quality yet undervalued this year, said Heather Brilliant, chief equities strategist.

Navigant is among the region's beaten-down stocks liked by stock research firm EVA Dimensions LLC. "Its fundamentals are improving, and it's really cheap," said EVA analyst Andrew Zamfotis.

Best of the best

Here are the top three stock gainers of 2012:

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Soccer coach suspended in Maine West hazing case

Another soccer coach linked to hazing allegations on athletic teams at Maine West High School has been suspended without pay by the district while officials pursue his dismissal.

Maine Township High School District 207 officials reached that decision on freshman boys soccer coach Emilio Rodriguez at a special board meeting Thursday night, a month after reaching the same decision on the employment of head varsity soccer coach Michael Divincenzo.

“The board believes Mr. Rodriguez violated District 207 Board of Education policy and professional expectations by failing to adequately prevent, recognize, report and punish student hazing,” board president Sean Sullivan said in a statement read at the meeting.

Both men were originally placed on paid leave and reassigned from teaching duties this fall when allegations of hazing surfaced in early October on the Des Plaines school’s soccer and baseball teams.

Those allegations are the subject of a lawsuit filed on behalf of four alleged hazing victims on the soccer team and against the district, both coaches and Maine West Principal Audrey Haugan.

Rodriguez, a tenured applied arts and technology teacher, has 17 days to request a hearing on his dismissal through the Illinois State Board of Education, officials said.

Through an attorney, Divincenzo recently requested an appeal hearing with the state board. The appeal process could take up to one year, officials said.

Rodriguez could not be reached for comment on Thursday night. But Des Plaines police reports show he and Divincenzo previously denied any knowledge of team hazing or initiation rituals.

District officials also fulfilled early promises made shortly after the hazing allegations surfaced by approving the hiring of former assistant U.S. attorney Sergio Acosta to lead the district’s independent investigation into hazing allegations, and California-based consultant Community Matters to lead focus groups studying bullying and hazing prevention techniques.

Last week, district officials confirmed the receipt of grand jury subpoenas in the Cook County state’s attorney’s ongoing investigation. Officials reiterated their commitment to “cooperate fully with all agencies conducting their own investigations, including the Cook County State’s Attorney, Des Plaines Police and the Illinois Department of Children and Family Services.

One subpoena, dated Dec. 6 and obtained by the Tribune, directs Maine West Principal Audrey Haugan to produce “personnel files, disciplinary records, reports, memorandums, summaries, interviews, investigations, notes, statements or other such writings or recordings for Michael Divincenzo and Emilio Rodriguez, and any and all other employees associated with coaching student athletes from 2007 to the present time.”

In another Dec. 6 subpoena, Superintendent Ken Wallace is directed to produce “any written materials describing or explaining” school, student athlete, coach or teacher conduct codes or rules, “or rules or any other similar such writings including but not limited to the topics of hazing, sexual misconduct or physical misconduct in any manner associated with Maine West High School.”

Wallace, Haugan, Maine East Principal Michael Pressler and Maine South Principal Shawn Messmer also received subpoenas dated Dec. 7. Those subpoenas, which were partially redacted, seek “any and all letters, emails, reports, memorandums, call logs, writings, recordings, or other such material regarding” redacted information, “including any such documents from within the school records or school file for” redacted information.

jbullington@tribune.com

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New PlayStation 4 details emerge: 8-core AMD ‘Bulldozer’ CPU, redesigned controller and more

2013 is a huge year for gamers. Nintendo (NTDOY) just launched the Wii U ahead of the holidays and both Sony (SNE) and Microsoft (MSFT) are expected to issue next-generation consoles before the year is through. We’ve seen plenty of rumors about both systems over the past few months, and the latest comes from Kotaku and focuses on Sony’s PlayStation 4.

[More from BGR: BlackBerry 10 said to be overhyped, RIM’s comeback chances remain slim]

The site claims to have gotten its hands on documents describing Sony’s developer system given to premier partners so they can build games ahead of the next-generation console launch. The specs, if accurate, will obviously line up with the release version of the system. Included in the specs Kotaku is reporting are an AMD64 “Bulldozer” CPU with eight cores total, an AMD GPU, 8GB of system RAM, 2.2GB of video memory, a 160GB hard drive, a Blu-ray drive, four USB 3.0 ports and more.

[More from BGR: Apple: ‘Bent, not broken’]

Sony also reportedly has a redesigned controller in the works that will include a capacitive touch pad.

This article was originally published on BGR.com

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Damon ‘hijacks’ Kimmel’s ABC show

NEW YORK (AP) — Matt Damon had his revenge.

The butt of a long-running joke on ABC’s “Jimmy Kimmel Live,” the actor opened Thursday night’s show as a kidnapper who tied Kimmel to a chair with duct tape and gagged him with his own tie.

“There’s a new host in town and his initials are M.D.,” Damon said. “That’s right, the doctor is in.”

For years, Kimmel has joked at the end of his show that he ran out of time and was unable to bring Damon on as a guest. Kimmel was the silent one Thursday, watching from the back of the stage as Damon did his job.

Damon tormented Kimmel by bringing on a succession of big-name guests. Robin Williams stopped by to finish the monologue. Ben Affleck had a walk-on role. Sheryl Crow was the bandleader and performed her new single. Nicole Kidman, Gary Oldman, Amy Adams, Reese Witherspoon and Demi Moore all crowded the talk show’s couch.

“I’ve been waiting for this moment for a long, long time,” Damon said. “This is like when I lost my virginity, except this is going to last way longer than one second.”

Damon’s guest hosting turn came at a key time for Kimmel. ABC earlier this month moved the show to 11:35 p.m. ET and PT after a decade of airing it a half hour later, putting him in direct competition with Jay Leno and David Letterman.

Thursday’s special program aimed for the same water-cooler status as a memorably lewd short film Damon made for the show a few years ago with Kimmel’s then-girlfriend, Sarah Silverman. It went viral and remains probably the best-known skit in the show’s history.

To twist the knife even further, Damon brought Silverman on as his final guest Thursday night, with Kimmel looking on forlornly as she likened their five-year relationship to an unfortunate trip to a hot dog vendor.

“Is there anything you’d like to say to Jimmy?” Damon asked.

“No, I’m good,” Silverman replied.

Then came the sweetest revenge of all, with Damon promising to ungag Kimmel in the show’s final minutes.

“Wait,” he said. “I’m sorry. We’re out of time.”

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HCA Must Pay Kansas City Foundation $162 Million

HCA, the nation’s largest profit-making hospital chain, was ordered on Thursday to pay $162 million after a judge in Missouri ruled that it had failed to abide by an agreement to make improvements to dilapidated hospitals that it bought in the Kansas City area several years ago.

The judge also ordered a court-appointed accountant to determine whether HCA had actually provided the levels of charitable care that it agreed to at the time.

The ruling came in response to a suit filed in 2009 by a community foundation that was created when HCA acquired the hospitals. Among other things, the foundation was responsible for ensuring that HCA met the obligations outlined in the deal.

The dispute in Kansas City is the second time in recent years that HCA has come under legal fire from officials in communities that sold troubled nonprofit community hospitals to HCA.

In another dispute in New Hampshire in 2011, a judge ruled in HCA’s favor, deciding that Portsmouth Regional Hospital would remain part of HCA after community leaders tried to regain control. During testimony in a 2011 trial, a former hospital official claimed he had difficulties getting HCA to pay for what he and others described as critical equipment and facility upgrades.

In an e-mailed statement, a spokesman for HCA said the company was disappointed in the court’s ruling and intended to appeal. He also added that the two cases were “rare exceptions” and that the company had enjoyed positive relationships with communities across the country.

The suit is among several problems for HCA. The company disclosed last year, for example, that the United States attorney’s office in Miami had subpoenaed documents as part of an inquiry to determine whether unnecessary cardiology procedures had been performed at HCA hospitals in Florida and elsewhere. At stake in that case is whether HCA inappropriately billed Medicare and private insurers for the procedures. HCA has denied any wrongdoing.

Financially, Thursday’s judgment is a slap on the wrist for HCA, which posted net income of $360 million in just the third quarter of last year. But the ruling may reverberate beyond HCA as communities across the country put their troubled nonprofit hospitals up for sale.

In many cases, the buyers with the deepest pockets have been profit-making hospital chains that want to convert the community hospitals to profit status, typically agreeing to spend money to fix them and to maintain certain levels of charitable care in the community.

In 2011, for instance, Vanguard Health Systems, which went public that year and has as its largest shareholder the private equity firm Blackstone Group, bought eight hospitals in Detroit. As part of that deal, Vanguard Health agreed to spend $850 million over five years to fix and maintain the hospitals.

The trouble in the Kansas City area began a year after HCA acquired a dozen hospitals from Health Midwest in 2003 for $1.125 billion. As part of the deal, HCA agreed to make $300 million in capital improvements in the first two years and an additional $150 million in the following three. The hospital chain also agreed to maintain the levels of care that had been provided to low-income individuals and families in the area for 10 years.

But when the members of the Health Care Foundation of Greater Kansas City, a nonprofit created from the proceeds of the sale of the hospital, received their first report from HCA in 2004 they discovered the hospital was already way behind.

Of the $300 million it was supposed to spend in the first two years, its own documents showed it had spent only about $50 million, according to Mark G. Flaherty, one of the founding members of the foundation and its general counsel.

HCA’s reports to the foundation also indicated that the level of charitable care it provided at the system’s large inner-city hospital had fallen while charitable care provided at the more affluent suburban hospital had risen sharply, Mr. Flaherty said.

“That was a big red flag to us,” he said.

After repeatedly asking HCA executives for explanations but receiving none, the foundation sued HCA in 2009. The case went to trial for several weeks in 2011.

HCA argued in the trial that it had met its obligation to spend money on hospital facilities by building two new hospitals at a cost of hundreds of millions of dollars, rather than repairing older facilities. But Judge John Torrence of Jackson County Circuit Court ruled that the agreement called for improvements to existing hospitals.

He said HCA still owed $162 million of the $300 million it had agreed to spend between 2003 and 2005. He then named a court-appointed forensic accountant to determine whether HCA had met its other capital commitments and whether it provided the charitable care it had said it would.

HCA’s own written statements claimed “differing amounts,” the judge wrote in his ruling. One HCA report said it provided $48 million in charitable care to the area in 2009 while another report on its Web site said it provided more than $87 million. The annual report to the foundation claimed it provided $185 million in uncompensated and charity care that year, the judge wrote.

During the trial, when asked about the widely differing numbers, the president of HCA’s Midwest division and other HCA executives had no explanation.

The money will be paid to the foundation, which will use it to create grants to provide care for uninsured or underinsured families in the area. It is unclear whether the spending on improvements will occur.

Depending on what the court-appointed accountant discovers, HCA may owe even more money, said Paul Seyferth of Seyferth Blumenthal & Harris, which represents the foundation.

“We think they’re going to have a tremendously difficult time convincing anybody that they spent what they claim they spent,” Mr. Seyferth said.

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