Community Health Systems (CYH) Q4 2025 earnings summary

Executive summary

• Fourth quarter 2025 results were in line with expectations, with margin expansion, improved payer mix, and cost controls, but net operating revenues declined 4.9% year-over-year and Adjusted EBITDA fell 7.7%.

• Full-year 2025 net operating revenues were $12.485 billion, down 1.2% year-over-year; Adjusted EBITDA was $1.526 billion, down 0.9% year-over-year.

• Net income attributable to stockholders was $110 million in Q4 2025 and $509 million for the full year, with Q4 benefiting from gains on asset sales.

• Divestitures in 2025 and early 2026 enabled reinvestment in core assets and significant debt reduction, with leverage dropping from 7.4x to 6.6x year-over-year.

• Strategic focus remains on enhancing quality, physician and patient experience, employee satisfaction, and cash flow growth to support long-term success.

Financial highlights

• Q4 2025 net operating revenues were $3.106 billion; Adjusted EBITDA was $395 million (12.7% margin).

• Same-store net revenue rose 2.1% year-over-year in Q4 and 4.6% for the full year, driven by a 2.4% increase in net revenue per adjusted admission.

• Cash flows from operations were $266 million in Q4 and $543 million for the full year; adjusted for divestiture taxes, full-year operating cash flow was $712 million.

• Supply expense declined 110 basis points year-over-year to 14.4% of net revenue in Q4.

• Net income per share excluding adjustments was $(0.42) in Q4 2025, $(1.03) for the full year.

Outlook and guidance

• 2026 guidance: net revenue of $11.6–$12.0 billion, Adjusted EBITDA of $1.34–$1.49 billion, operating cash flow of $600–$700 million, and capital expenditures of $350–$400 million.

• Net loss per share (diluted) expected between $(0.60) and $0.00 for 2026.

• Guidance reflects the impact of completed and pending divestitures, and excludes one-time items from 2025.

• Core operations expected to grow about 4% off the adjusted 2025 EBITDA base, net of a $20–$30 million EBITDA impact from reduced health insurance exchange (HIX) enrollment.

• An extra payroll period in 2026 will create a $140 million headwind to operating cash flow.