Community Health Systems (CYH) Q4 2025 earnings summary

Executive summary

• Fourth quarter 2025 results met updated expectations, with sequential margin expansion, improved payer mix, and cost controls, but net operating revenues declined 4.9% year-over-year and Adjusted EBITDA decreased 7.7% in Q4 2025.

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

• Net income attributable to stockholders in Q4 2025 was $110 million ($0.81 per diluted share), with full-year net income of $509 million ($3.77 per share), both improved from prior year losses.

• Divestitures in 2025 and early 2026 streamlined the portfolio, reduced leverage, and enabled reinvestment in growth and debt reduction.

• Leadership transition completed, with new CEO and CFO focused on quality, experience, satisfaction, and cash flow growth.

Financial highlights

• Adjusted EBITDA for Q4 2025 was $395 million (12.7% margin), slightly up year-over-year after adjusting for divestitures and one-time items.

• Q4 2025 net operating revenues were $3.106 billion; same-store net revenue for Q4 increased 2.1% year-over-year, driven by a 2.4% rise 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.

• Adjusted free cash flow for 2025 was $150 million.

• Net income benefited from a net gain on sale of businesses in Q4 2025.

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 impact of completed and pending divestitures, and excludes one-time 2025 items and potential new state payment programs.

• Core operations expected to grow about 4% off the adjusted 2025 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.