Health Management Associates Inc. shareholders have approved the company's sale to competitor Community Health Systems. HMA's board recommended in November that shareholders vote for the sale. The purchase includes HMA's newly built Poplar Bluff Regional Medical Center, a key provider of health services to the poor in several rural counties of southeast Missouri. The deal values Naples, Fla.-based HMA at $13.78 per share. The companies have put the total value of the cash-and-stock transaction at $7.6 billion, including HMA's debt. Community Health Systems Inc., which is based in Franklin, Tenn., offered to buy HMA in late June.