A judge has ordered HCA to pay almost $434 million to the Health Care Foundation of Greater Kansas City for failing to follow through on promises made more than a decade ago when it bought the assets of one of the region’s largest hospital systems.

In 2003, Nashville-based HCA purchased Health Midwest, based in Kansas City. The deal required HCA to make at least $450 million in capital improvements during its first five years of ownership and provide the region with $653 million a year in charity care over 10 years. The foundation, created after the deal, filed a lawsuit against HCA in 2009 alleging it failed to keep its agreement.