Tenet Healthcare (THC) Q4 2025 earnings summary

Executive summary

• Net operating revenues reached $21.31 billion in 2025, with consolidated Adjusted EBITDA of $4.57 billion, up 14% year-over-year.

• Q4 2025 Adjusted EBITDA was $1.183 billion, up 13% year-over-year, with Adjusted Diluted EPS up 37%.

• Free cash flow for 2025 totaled $2.53 billion, supporting growth and deleveraging, with a leverage ratio of 2.25x EBITDA.

• Strong performance was driven by same-store revenue growth, high acuity, and disciplined cost control.

• Major transactions, including the CommonSpirit/Conifer deal, will impact 2026 results with $1.65 billion contract termination revenue and $500 million tax expense.

Financial highlights

• Q4 2025 net operating revenues were $5.53 billion, up 8.9% year-over-year; Adjusted EBITDA margin was 21.4%.

• Full-year 2025 Adjusted EBITDA margin was 21.4%, up 210 basis points from 2024.

• Free cash flow for 2025 was $2.53 billion; $2.8–$2.9 billion cash on hand at year-end.

• Leverage ratio at year-end was 2.25x EBITDA, improved from 2.54x in 2024.

• Repurchased 8.8 million shares for $1.386 billion in 2025.

Outlook and guidance

• FY 2026 Adjusted EBITDA guidance: $4.485–$4.785 billion; net operating revenues: $21.5–$22.3 billion.

• Adjusted free cash flow for 2026 projected at $2.5–$3.29 billion.

• FY 2026 net income available to common shareholders forecast at $2.605–$2.84 billion; adjusted diluted EPS expected at $16.19–$18.47.

• Guidance assumes 1%-2% same hospital admission growth and 3%-6% USPI same-facility revenue growth.

• $250 million EBITDA headwind expected from expiration of enhanced premium tax credits.