Tenet Healthcare (THC) Q4 2025 earnings summary

Executive summary

• Net operating revenues for 2025 reached $21.31 billion, with consolidated Adjusted EBITDA of $4.57 billion, up 14% year-over-year, and Q4 2025 Adjusted EBITDA of $1.183 billion, up 13% year-over-year.

• Adjusted EBITDA margin improved by over 200 basis points to 21.4% for the year, with Q4 2025 margin at 21.4%.

• Adjusted diluted EPS rose 36.6% year-over-year to $4.70 in Q4 2025; full-year net income was $1.407 billion, or $15.49 per diluted share.

• Nearly $350 million invested in M&A and de novo activity, adding 35 facilities in 2025.

• Entered into a significant transaction with CommonSpirit Health, resulting in $1.65 billion contract termination revenue and $500 million incremental tax expense in 2026.

Financial highlights

• Q4 2025 net operating revenues were $5.53 billion, up 8.9% year-over-year; full-year 2025 net operating revenues were $21.31 billion, up 3.1%.

• Free cash flow for 2025 was $2.53 billion, with cash on hand at year-end of $2.8–$2.9 billion and no significant debt maturities until late 2027.

• Net debt to Adjusted EBITDA ratio improved to 2.25x at year-end 2025 from 2.54x a year earlier.

• Adjusted net income for Q4 2025 was $413 million, up from $330 million in Q4 2024.

• FY 2025 capital expenditures totaled $1.01 billion.

Outlook and guidance

• FY 2026 consolidated net operating revenues projected at $21.5–$22.3 billion; Adjusted EBITDA guidance is $4.485–$4.785 billion.

• Adjusted diluted EPS for 2026 expected at $16.19–$18.47; net income forecast at $2.605–$2.84 billion.

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

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

• $250 million EBITDA headwind expected from expiration of enhanced premium tax credits, primarily impacting the hospital segment.