Community Health Systems (CYH)

Next 12 Months: Starting Case

$ in millions	Last 12 Months	Next Quarter (4Q26E)	vs. 4Q25A	Next 12 Months	Change
Revenue	$11,653	$2,785	(10.4%)	$11,133	(4.5%)
Adj. EBITDA	$1,467	$323	(42.6%)	$1,216	(17.1%)
Free Cash Flow	($122)	$11	(93.7%)	($34)	71.9%
Net Debt, end of period	$9,431	$9,420		$9,465	0.4%
Net Debt / Adj. EBITDA	6.4x	7.7x		7.8x	+1.4x
Total Liquidity, end of period	$900	$911		$866	(3.8%)

The credit over the next year

CHS is now a 60 hospital operator in mostly smaller markets, and the credit turns on whether same-store volume and pricing grow faster than labor and purchased services costs while divestitures shrink the base. Same-store adjusted admissions rose 3.6% in the third quarter of 2026, but revenue per adjusted admission was up only 0.2% on a weaker payor mix, and other operating expenses climbed to 29.3% of revenue on supplemental program taxes and specialist fees, so Adjusted EBITDA fell to $280mm. Over the next year the swing factors are Medicaid supplemental payments and payor mix after the federal 2025 reconciliation law, wage inflation per adjusted admission, and how much of the roughly $9.4bn of secured notes due 2029 to 2034 can be refinanced or paid down with sale proceeds.

Leverage rises from 6.4x to 7.8x over the next four quarters on the starting case.
The company burns $34mm of cash over the next year on the starting case, so liquidity has to fund it.
Net debt is roughly unchanged from $9.43bn to $9.47bn.
Liquidity a year out is $866mm, against $900mm today.
Company guidance for fiscal 2026: adjusted EBITDA of $1.23bn to $1.28bn on its own definition.

Built from the inputs on the Projections tab of the model; change them there. A starting case from history, not a forecast.

Capital Structure

Cap Structure	Amt Out.	Mkt Price	Yield	Lev. Through	View
Unrestricted Cash	$155.0
6.875% Junior-Priority Secured Notes due 2029	1,244.0	100.0%	6.87%	0.8x	Neutral
6.000% Senior Secured Notes due 2029	644.0	100.0%	6.00%	1.3x	Neutral
ABL Facility	0.0	100.0%	N/a	1.3x	Neutral
5.250% Senior Secured Notes due 2030	1,535.0	100.0%	5.25%	2.3x	Neutral
6.125% Junior-Priority Secured Notes due 2030	1,227.0	100.0%	6.13%	3.2x	Bearish
4.750% Senior Secured Notes due 2031	689.0	100.0%	4.75%	3.6x	Bearish
10.875% Senior Secured Notes due 2032	1,549.0	100.0%	10.87%	4.7x	Bearish
10.750% Senior Secured Notes due 2033	700.0	100.0%	10.75%	5.2x	Bearish
9.750% Senior Secured Notes due 2034	1,790.0	100.0%	9.75%	6.4x	Bearish
Finance lease and financing obligations	300.0	100.0%	N/a	6.6x	Bearish
6.875% Senior Notes due 2028	42.0	100.0%	6.87%	6.6x	Bearish
Other debt	46.0	100.0%	N/a	6.7x	Bearish
Total Debt	$9,586.0			6.5x
Net Debt	$9,431.0			6.4x

Last Twelve Months

Revenue	$11,653
Implied Costs	(10,186)
Adj. EBITDA	$1,467
(-) Interest Expense	(832)
(-) Capex	(333)
Memo: FCF	($122)
Total Liquidity	$900.0

Next 12 months, starting case▼ Revenue $11.65bn → $11.13bn▼ Adj. EBITDA $1.47bn → $1.22bn▲ Free cash flow -$122mm → -$34mm▲ Net leverage 6.4x → 7.8x▼ Liquidity $900mm → $866mm

Community Health Systems

			9/30/26						Face Value / Adj. EBITDA
Cap Structure	Coupon	Maturity	Amt Out.	Mkt Price	YTM	Next Call	Yield to Call	View	2021A	2022A	2023A	2024A	2025A	LTM	3Q27E LTM	3Q28E LTM
Unrestricted Cash			$155.0
Undrawn Revolver ($1,000mm facility)			745.0
Total Liquidity			$900.0

6.875% Junior-Priority Secured Notes due 2029	6.875%	4/15/2029	1,244.0	100.0%	6.87%	4/15/2026 @ 100	6.87%	Neutral
6.000% Senior Secured Notes due 2029	6.00%	1/15/2029	644.0	100.0%	6.00%	1/15/2026 @ 100	6.00%	Neutral
ABL Facility	S + 175 to 225	6/5/2029	0.0	100.0%	N/a	N/a	N/a	Neutral
5.250% Senior Secured Notes due 2030	5.25%	5/15/2030	1,535.0	100.0%	5.25%	5/15/2027 @ 100	5.25%	Neutral
6.125% Junior-Priority Secured Notes due 2030	6.125%	4/1/2030	1,227.0	100.0%	6.13%	4/1/2027 @ 100	6.13%	Bearish
4.750% Senior Secured Notes due 2031	4.75%	2/15/2031	689.0	100.0%	4.75%	2/15/2027 @ 101.583	7.92%	Bearish
10.875% Senior Secured Notes due 2032	10.875%	1/15/2032	1,549.0	100.0%	10.87%	2/15/2027 @ 105.438	21.75%	Bearish
10.750% Senior Secured Notes due 2033	10.75%	6/15/2033	700.0	100.0%	10.75%	6/15/2030 @ 110.75	13.26%	Bearish
9.750% Senior Secured Notes due 2034	9.75%	1/15/2034	1,790.0	100.0%	9.75%	8/15/2028 @ 104.875	11.98%	Bearish
Finance lease and financing obligations	N/a	N/a	300.0	100.0%	N/a	N/a	N/a	Bearish
Total Secured Debt			$9,678.0						4.9x	7.0x	6.5x	9.3x	5.0x	6.6x	8.0x	8.0x
Net Secured Debt			$9,523.0						4.8x	6.9x	6.4x	9.1x	4.9x	6.5x	7.8x	7.8x

6.875% Senior Notes due 2028	6.875%	4/1/2028	42.0	100.0%	6.87%	4/1/2025 @ 100	6.87%	Bearish
Other debt	N/a	N/a	46.0	100.0%	N/a	N/a	N/a	Bearish
Other debt, discounts and issuance costs	N/a	N/a	(180.0)
Total Debt			$9,586.0						4.9x	7.0x	6.5x	9.2x	5.0x	6.5x	7.9x	7.9x
Net Debt			$9,431.0						4.8x	6.9x	6.4x	9.0x	4.9x	6.4x	7.8x	7.8x
						Adj. EBITDA			$1,970	$1,375	$1,484	$1,045	$1,925	$1,467	$1,216	$1,216

Key Financials

	2021A	2022A	2023A	2024A	2025A	LTM	3Q27E LTM	3Q28E LTM
Revenue	$12,368	$12,211	$12,490	$12,634	$12,485	$11,653	$11,133	$11,133
Y/Y Growth		(1.3%)	2.3%	1.2%	(1.2%)		(4.5%)	0.0%
(-) Cost of Revenue	(2,042)	(1,975)	(1,993)	(1,946)	(1,864)	(1,695)	(1,612)	(1,612)
Gross Profit	$10,326	$10,236	$10,497	$10,688	$10,621	$9,958	$9,521	$9,521
Gross Margin	83.5%	83.8%	84.0%	84.6%	85.1%	85.5%	85.5%	85.5%
(+/-) Other Operating Costs, net of D&A	(8,384)	(8,881)	(9,035)	(9,660)	(8,707)	(8,255)	(8,317)	(8,317)
EBITDA	$1,942	$1,355	$1,462	$1,028	$1,914	$1,703	$1,204	$1,204
(+) Add-backs: stock comp, restructuring, impairments	28	20	22	17	11	(236)	12	12
Adj. EBITDA	$1,970	$1,375	$1,484	$1,045	$1,925	$1,467	$1,216	$1,216
Margin	15.9%	11.3%	11.9%	8.3%	15.4%	12.6%	10.9%	10.9%
(-) Restructuring and other cash add-backs	(3)	--	--	--	--	--	--	--
Cash EBITDA	$1,967	$1,375	$1,484	$1,045	$1,925	$1,467	$1,216	$1,216
(-) Interest Expense (Cash Only)	(778)	(835)	(801)	(741)	(804)	(832)	(798)	(798)
(-) Cash Taxes	4	6	(91)	(171)	(249)	(133)	(133)	(133)
(-) Capex	(469)	(415)	(467)	(360)	(335)	(333)	(318)	(318)
(+/-) Working Capital and Other	(1,324)	(246)	(382)	347	(329)	(291)	--	--
Memo: FCF	($600)	($115)	($257)	$120	$208	($122)	($34)	($34)
% of Debt	(6.3%)	(1.2%)	(2.7%)	1.3%	2.2%	(1.3%)	(0.4%)	(0.4%)

Liquidity

Unrestricted Cash	$155.0
Undrawn Revolver	745.0
Total Liquidity	$900.0
(-) Debt due through 2028	(42.0)
(+/-) Free cash flow, last twelve months	(122.0)
Liquidity after maturities and a year of cash flow	$736.0

Tranches are from the debt table in the latest quarterly or annual report.Blue figures are inputs in the model. Price is 100% of face unless marked *, which is a bond fund's own valuation from its SEC holdings report, not a traded price.Secured and unsecured are judged from each instrument's name. Adj. EBITDA is operating income plus D&A, stock compensation, restructuring and impairment charges as tagged in SEC filings; it is not the company's own adjusted figure. Free cash flow is cash from operations less capital spending.

The basket review for this company has not finished yet. When it does, this tab shows the dollar capacity to move value or prime lenders, the playbook moves that fit, and what they would do to each tranche. Meanwhile, see the liability management playbook.

The governing debt documents are listed and linked below. The review of baskets and loopholes, and the score, have not been run for this company yet.

All debt documents

Jun 5, 2024Second Amendment and Restatement Agreement to the Amended and Restated ABL Credit Agreement (restated credit agreement attached as Annex I) · ABL or receivables facility · ABL Facility
Aug 12, 2025Indenture for the 9.750% Senior Secured Notes due 2034 · indenture · 9.750% Senior Secured Notes due 2034
Dec 22, 2023Indenture for the 10.875% Senior Secured Notes due 2032 · indenture · 10.875% Senior Secured Notes due 2032
Feb 4, 2022Indenture for the 5.250% Senior Secured Notes due 2030 · indenture · 5.250% Senior Secured Notes due 2030
Feb 2, 2021Indenture for the 6.875% Junior-Priority Secured Notes due 2029 · indenture · 6.875% Junior-Priority Secured Notes due 2029
May 19, 2021Indenture for the 6.125% Junior-Priority Secured Notes due 2030 · indenture · 6.125% Junior-Priority Secured Notes due 2030
May 9, 2025Indenture for the 10.750% Senior Secured Notes due 2033 · indenture · 10.750% Senior Secured Notes due 2033
Feb 9, 2021Indenture for the 4.750% Senior Secured Notes due 2031 · indenture · 4.750% Senior Secured Notes due 2031
Dec 28, 2020Indenture for the 6.000% Senior Secured Notes due 2029 · indenture · 6.000% Senior Secured Notes due 2029
Feb 4, 2022Amended and Restated Senior-Junior Lien Intercreditor Agreement · intercreditor or security agreement · All series of Senior Secured Notes and both series of Junior-Priority Secured Notes (lien ranking between senior-priority and junior-priority debt)
Feb 4, 2022Second Amended and Restated ABL Intercreditor Agreement · intercreditor or security agreement · ABL Facility, all series of Senior Secured Notes and both series of Junior-Priority Secured Notes (lien ranking on ABL collateral and non-ABL collateral)
Aug 17, 2012First Lien Intercreditor Agreement · intercreditor or security agreement · All series of Senior Secured Notes (relations among the equal-ranking senior-priority series)
Nov 19, 2019Second Amended and Restated Guarantee and Collateral Agreement (senior-priority collateral) · intercreditor or security agreement · All series of Senior Secured Notes (guarantees and collateral)
Feb 2, 2021Amended and Restated Junior-Priority Collateral Agreement · intercreditor or security agreement · 6.875% Junior-Priority Secured Notes due 2029 and 6.125% Junior-Priority Secured Notes due 2030 (collateral)
Apr 3, 2018Guarantee and Collateral Agreement to the ABL Credit Agreement · intercreditor or security agreement · ABL Facility (guarantees and collateral)
Jun 22, 2018Junior-Priority Lien Pari Passu Intercreditor Agreement · intercreditor or security agreement · 6.875% Junior-Priority Secured Notes due 2029 and 6.125% Junior-Priority Secured Notes due 2030 (relations among junior-priority series)
Nov 9, 2026Press release announcing the exchange offer and consent solicitation for the 6.875% Junior-Priority Secured Notes due 2029 (describes the exchange offer support agreement, which is not itself filed) · other · 6.875% Junior-Priority Secured Notes due 2029 and 6.125% Junior-Priority Secured Notes due 2030 (proposed exchange into new 10.250% Senior Secured Notes due 2035)
Jun 5, 2024First Supplemental Indenture for the 10.875% Senior Secured Notes due 2032 (tack-on notes) · supplemental indenture · 10.875% Senior Secured Notes due 2032
Nov 19, 2019Indenture for the 6.875% Senior Unsecured Notes due 2028 · indenture · 6.875% Senior Notes due 2028
May 8, 2025Fourth Supplemental Indenture for the 6.875% Senior Unsecured Notes due 2028 (removes most covenants after the 2025 tender offer) · supplemental indenture · 6.875% Senior Notes due 2028
Apr 30, 2024Collateral Agency Transfer Agreement (Credit Suisse to U.S. Bank Trust Company as senior-priority collateral agent) · intercreditor or security agreement · All series of Senior Secured Notes (change of collateral agent)
Nov 13, 2023First Supplemental Indenture for the 5.250% Senior Secured Notes due 2030 · supplemental indenture · 5.250% Senior Secured Notes due 2030
Nov 13, 2023First Supplemental Indenture for the 6.875% Junior-Priority Secured Notes due 2029 · supplemental indenture · 6.875% Junior-Priority Secured Notes due 2029
Nov 13, 2023First Supplemental Indenture for the 6.125% Junior-Priority Secured Notes due 2030 · supplemental indenture · 6.125% Junior-Priority Secured Notes due 2030
Nov 13, 2023First Supplemental Indenture for the 4.750% Senior Secured Notes due 2031 · supplemental indenture · 4.750% Senior Secured Notes due 2031
Nov 13, 2023First Supplemental Indenture for the 6.000% Senior Secured Notes due 2029 · supplemental indenture · 6.000% Senior Secured Notes due 2029
Nov 13, 2023Third Supplemental Indenture for the 6.875% Senior Unsecured Notes due 2028 · supplemental indenture · 6.875% Senior Notes due 2028
Dec 11, 2020Second Supplemental Indenture for the 6.875% Senior Unsecured Notes due 2028 · supplemental indenture · 6.875% Senior Notes due 2028
Mar 27, 2020First Supplemental Indenture for the 6.875% Senior Unsecured Notes due 2028 · supplemental indenture · 6.875% Senior Notes due 2028
Dec 28, 2020Indenture for the 5.625% Senior Secured Notes due 2027 (notes fully retired in 2025) · indenture · 5.625% Senior Secured Notes due 2027 (repaid; still named in the ABL Facility springing maturity test) · repaid
Nov 19, 2019Indenture for the 8.000% Senior Secured Notes due 2027 (notes fully redeemed in May 2025) · indenture · 8.000% Senior Secured Notes due 2027 (repaid) · repaid

Scores and summaries are an analyst-style reading of the documents produced with AI and checked against the text. They are not legal advice. Read the document before relying on any point.

Key Financials

	2021A	2022A	2023A	2024A	2025A	LTM	3Q27E LTM	3Q28E LTM
Revenue	$12,368	$12,211	$12,490	$12,634	$12,485	$11,653	$11,133	$11,133
Y/Y Growth		(1.3%)	2.3%	1.2%	(1.2%)		(4.5%)	0.0%
(-) Cost of Revenue	(2,042)	(1,975)	(1,993)	(1,946)	(1,864)	(1,695)	(1,612)	(1,612)
Gross Profit	$10,326	$10,236	$10,497	$10,688	$10,621	$9,958	$9,521	$9,521
Gross Margin	83.5%	83.8%	84.0%	84.6%	85.1%	85.5%	85.5%	85.5%
(+/-) Other Operating Costs, net of D&A	(8,384)	(8,881)	(9,035)	(9,660)	(8,707)	(8,255)	(8,317)	(8,317)
EBITDA	$1,942	$1,355	$1,462	$1,028	$1,914	$1,703	$1,204	$1,204
(+) Add-backs: stock comp, restructuring, impairments	28	20	22	17	11	(236)	12	12
Adj. EBITDA	$1,970	$1,375	$1,484	$1,045	$1,925	$1,467	$1,216	$1,216
Margin	15.9%	11.3%	11.9%	8.3%	15.4%	12.6%	10.9%	10.9%
(-) Restructuring and other cash add-backs	(3)	--	--	--	--	--	--	--
Cash EBITDA	$1,967	$1,375	$1,484	$1,045	$1,925	$1,467	$1,216	$1,216
(-) Interest Expense (Cash Only)	(778)	(835)	(801)	(741)	(804)	(832)	(798)	(798)
(-) Cash Taxes	4	6	(91)	(171)	(249)	(133)	(133)	(133)
(-) Capex	(469)	(415)	(467)	(360)	(335)	(333)	(318)	(318)
(+/-) Working Capital and Other	(1,324)	(246)	(382)	347	(329)	(291)	--	--
Memo: FCF	($600)	($115)	($257)	$120	$208	($122)	($34)	($34)
% of Debt	(6.3%)	(1.2%)	(2.7%)	1.3%	2.2%	(1.3%)	(0.4%)	(0.4%)

Key Drivers

Driver	4Q25A	1Q26A	2Q26A	3Q26A	4Q26E	1Q27E	2Q27E	3Q27E	4Q27E	1Q28E	2Q28E	3Q28E	Sensitivity	Next 12m impact ($mm)
Adjusted admissions (consolidated) thousands per quarter	222.3	206.5	196.9	195.7	195.0	195.0	195.0	195.0	195.0	195.0	195.0	195.0	$14.1mm on revenue	(584)
Net revenue per adjusted admission $ per adjusted admission	13,973	14,359	14,346	14,090	14,290	14,359	14,346	14,090	14,290	14,359	14,346	14,090	$0.2mm on revenue	63
Salaries and benefits per adjusted admission $ per adjusted admission	6,096	6,402	6,282	6,199	6,194	6,402	6,282	6,199	6,194	6,402	6,282	6,199	$0.2mm on other operating costs	20
Supplies per adjusted admission $ per adjusted admission	2,006	2,136	2,036	2,080	2,014	2,136	2,036	2,080	2,014	2,136	2,036	2,080	$0.2mm on cost of revenue	2
Other operating expenses per adjusted admission $ per adjusted admission	3,792	4,010	4,058	4,134	4,919	4,010	4,058	4,134	4,919	4,010	4,058	4,134	$0.2mm on other operating costs	225

CHS is now a 60 hospital operator in mostly smaller markets, and the credit turns on whether same-store volume and pricing grow faster than labor and purchased services costs while divestitures shrink the base. Same-store adjusted admissions rose 3.6% in the third quarter of 2026, but revenue per adjusted admission was up only 0.2% on a weaker payor mix, and other operating expenses climbed to 29.3% of revenue on supplemental program taxes and specialist fees, so Adjusted EBITDA fell to $280mm. Over the next year the swing factors are Medicaid supplemental payments and payor mix after the federal 2025 reconciliation law, wage inflation per adjusted admission, and how much of the roughly $9.4bn of secured notes due 2029 to 2034 can be refinanced or paid down with sale proceeds.

Bottoms-Up Projections: starting case

$ in millions	4Q25A	1Q26A	2Q26A	3Q26A	4Q26E	1Q27E	2Q27E	3Q27E	4Q27E	1Q28E	2Q28E	3Q28E
Revenue	$3,106	$2,965	$2,825	$2,757	$2,785	$2,803	$2,798	$2,747	$2,785	$2,803	$2,798	$2,747
Y/Y Growth	(4.9%)	(6.1%)	(9.8%)	(10.7%)	(10.4%)	(5.5%)	(0.9%)	(0.4%)	0.0%	0.0%	0.0%	0.0%
Adj. EBITDA	$563	$308	$327	$269	$323	$293	$328	$272	$323	$293	$328	$272
Margin	18.1%	10.4%	11.6%	9.8%	11.6%	10.5%	11.7%	9.9%	11.6%	10.5%	11.7%	9.9%
Free Cash Flow	$172	($373)	$12	$67	$11	($20)	$15	($40)	$11	($20)	$15	($40)
Cash, end of period	260	712	149	155	166	146	160	121	132	112	126	87
Total Debt, end of period	10,396	10,156	9,578	9,586	9,586	9,586	9,586	9,586	9,586	9,586	9,586	9,586
Net Debt / Adj. EBITDA	6.0x	5.8x	6.0x	6.4x	7.7x	7.8x	7.8x	7.8x	7.8x	7.8x	7.8x	7.8x

Revenue is built from Managed Care and Other Third Party Payors, Medicare Managed Care, Medicare, Medicaid, Self Pay Revenue, each driven by volume and by price and mix against the same quarter a year earlier. Every cost line, interest, taxes, capital spending and working capital has its own input on the Projections tab of the model. This is a starting case built from history, not a forecast.

Earnings call: Q3 2026 · Oct 29, 2026

Slides Webcast and audio replay Investor relations site

Community Health Systems cut 2026 guidance again as weaker payor mix and acuity hit margins, then moved to swap its 2029 junior-lien notes into new 2035 senior secured notes.

Takeaways

Revenue fell 10.7% to $2.757 billion because of hospital sales, but grew 3.8% on a same-store basis. Same-store adjusted admissions rose 3.6% and surgeries rose 2.0%.
Margins weakened. Adjusted EBITDA fell 25.5% to $280 million and the margin dropped 200 basis points to 10.2%. Management blamed payor mix and acuity, plus a $28 million legal settlement in the prior-year quarter.
Payor mix shifted the wrong way. Managed care and other fell to 46.1% of revenue from 48.5%, while Medicare managed care and self-pay rose. Uncompensated care jumped to 32.9% of adjusted revenue from 25.2%.
Cash flow improved in the quarter but is weak for the year. Operating cash flow was $155 million versus $70 million a year ago, yet the nine months show a $55 million outflow. Same-store days revenue outstanding rose to 59 from 54 at year end.
Asset sales keep shrinking debt. Nine-month divestiture proceeds were about $1.21 billion, and total debt fell to $9.586 billion from $10.396 billion at year end. Ten hospitals have been sold in 2026, leaving 59.
Liquidity is thin but intact. Cash was $155 million and the $1.0 billion ABL was undrawn with about $745 million available. Debt is high against roughly $1.25 billion of guided EBITDA, near 7.7 times on our rough math.

Debt and capital

Total debt was $9.586 billion at September 30, 2026, all fixed rate. Nothing was drawn on the $1.0 billion ABL. Nine-month gross repayments were about $2.15 billion, which includes paying back $1.31 billion of ABL draws.
No bond maturities until 2028. The maturity chart shows first-lien, second-lien and unsecured towers spread from 2028 through 2034.
On November 9, 2026, the issuer announced a private exchange offer for all $1.244 billion of its 6.875% junior-priority secured notes due 2029. Holders would get new 10.250% senior secured notes due January 2035, at par with a $30 early premium.
The new notes would rank first lien on the notes collateral and second lien on the ABL collateral, so the deal moves debt up the priority stack. The early tender deadline is November 23 and expiry is December 10, 2026.
Holders owning about 52% of the 2029 notes signed a support agreement, so the consent to strip most covenants from the old indenture is expected to pass. Those holders also agreed to swap some 6.125% junior-priority notes due 2030 at 87% of par for any 2029 notes left out.
Interest cost goes up sharply on the exchanged debt, from 6.875% to 10.250%, in return for three more years of runway on the 2029 tower.

Guidance

Cut. 2026 adjusted EBITDA now $1.225 to $1.275 billion, down from $1.300 to $1.375 billion in July.
Cut. Net operating revenue now $11.3 to $11.5 billion, down from $11.4 to $11.6 billion.
Cut. Operating cash flow now $100 to $300 million, down from $300 to $500 million. Expected cash taxes were lowered to $10 to $20 million from $30 to $50 million.
Cut. Diluted loss per share now $(1.70) to $(1.60), from $(1.25) to $(1.10).
Held. Capital spending still $350 to $400 million. Interest expense guided at $820 to $830 million, with cash interest of $800 to $810 million.
This was another downward revision after July. Management pointed to the tough macro backdrop for the rest of the year.

Tone: Defensive. Management stressed volume gains and strategic progress but cut guidance again and turned to a liability management exchange to push out maturities.

Q2 2026Slides · Webcast
Q1 2026Slides · Webcast
Q4 2025Slides · Webcast

Summary written with AI from Press release and slides only. Community Health Systems does not publish a call transcript or prepared remarks on its IR site or with the SEC.. Slides, audio and any transcript are the company's and open on its own site. Full transcripts from transcript vendors are not reproduced here.

Last quarter: Third quarter 2026

Adjusted EBITDA fell to $280mm from $376mm on divestitures and weaker payor mix, and full-year guidance was cut.

Results

Third quarter net operating revenue was $2.76bn, down 10.7% from $3.09bn a year earlier, mainly because of hospital sales. Same-store revenue rose 3.8%.
Adjusted EBITDA was $280mm against $376mm a year earlier.
Cash from operations was $155mm in the quarter against $70mm. For the nine months it was negative $55mm against positive $277mm.
Net loss to stockholders was $86mm, or $0.63 per share, against net income of $130mm. Excluding the company's adjusting items the loss was $0.48 per share.
For the nine months, revenue was $8.55bn and adjusted EBITDA was $918mm against $1.13bn.

Why

Same-store admissions rose 2.2% and adjusted admissions rose 3.6%, so volume was not the problem.
The company says payor mix and acuity came in weaker than it expected, which hurt revenue quality.
Medical specialist fees and supplemental reimbursement program expense were higher. The prior-year quarter also included $28mm from a legal settlement.
Ten hospitals have been divested in 2026 to date, including one effective October 1, which removes revenue and EBITDA from the comparison. The company had 60 hospitals at quarter end.

Balance sheet and guidance

Cash was $155mm at September 30, 2026, down from $260mm at December 31, 2025. Long-term debt was $9.57bn, down from $10.38bn.
The asset-based revolver was undrawn with about $745mm of borrowing capacity after $32mm of letters of credit.
Proceeds from hospital and other asset sales were $1.21bn in the nine months and debt repayments were $2.15bn against $1.31bn of revolver borrowings.
Full-year 2026 guidance was cut. Net operating revenue is now $11.3bn to $11.5bn, down from $11.4bn to $11.6bn in July.
Adjusted EBITDA is now $1.225bn to $1.275bn, down from $1.3bn to $1.375bn in July.
Cash from operations is now $100mm to $300mm, down from $300mm to $500mm. Capital spending was held at $350mm to $400mm.
Interest expense is expected at $820mm to $830mm, with cash interest of $800mm to $810mm. The net loss per share guide is $1.70 to $1.60.

What to watch

Payor mix and acuity. Management blames both for the miss and for the lower full-year outlook, and expiring exchange subsidies are listed among its risk factors.
Cash generation against the interest bill. Cash from operations is guided at $100mm to $300mm for the year, capital spending at $350mm to $400mm and cash interest at $800mm to $810mm, so asset sale proceeds are covering the gap.
The fourth quarter needs adjusted EBITDA of roughly $307mm to $357mm to land inside the new range, above the $280mm just reported.

From the company's press release filed Oct 28, 2026. Figures in this section are as the company reports them, including its own adjusted EBITDA.

Filings

Earnings releases 8

Oct 28, 20268-K for Oct 28, 2026: Results; Regulation FD · Press release
Jul 22, 20268-K for Jul 22, 2026: Results; Regulation FD · Press release
Apr 21, 20268-K for Apr 21, 2026: Results; Regulation FD · Press release
Feb 18, 20268-K for Feb 18, 2026: Results; Regulation FD · Press release
Oct 23, 20258-K for Oct 23, 2025: Results; Regulation FD · Press release
Jul 23, 20258-K for Jul 23, 2025: Results; Regulation FD · Press release
Apr 23, 20258-K for Apr 23, 2025: Results; Regulation FD · Press release
Feb 18, 20258-K for Feb 18, 2025: Results; Regulation FD · Press release

Annual reports (10-K) 5

Quarterly reports (10-Q) 12

Current reports (8-K) 20

Nov 10, 20268-K for Nov 9, 2026: Other event
Jun 1, 20268-K for Jun 1, 2026: Acquisition or disposal completed; Other event
May 13, 20268-K for May 13, 2026: Shareholder vote
May 6, 20268-K for May 6, 2026: Other event
Apr 23, 20268-K for Apr 22, 2026: Other event
Apr 1, 20268-K for Apr 1, 2026: Acquisition or disposal completed; Other event
Mar 5, 20268-K for Mar 5, 2026: Material agreement; Other event
Feb 11, 20268-K for Feb 11, 2026: Director or officer change
Feb 2, 20268-K for Feb 1, 2026: Acquisition or disposal completed; Other event
Jan 20, 20268-K for Jan 20, 2026: Material agreement; Other event
Dec 10, 20258-K for Dec 10, 2025: Director or officer change
Dec 2, 20258-K for Dec 1, 2025: Acquisition or disposal completed; Other event
Oct 31, 20258-K for Oct 30, 2025: Material agreement; Other event
Sep 30, 20258-K for Sep 30, 2025: Director or officer change
Sep 10, 20258-K for Sep 10, 2025: Director or officer change
Aug 12, 20258-K for Aug 11, 2025: Material agreement; New debt; Other event
Jul 29, 20258-K for Jul 28, 2025: Other event
Jul 23, 20258-K for Jul 23, 2025: Director or officer change
Jul 22, 20258-K for Jul 22, 2025: Material agreement; Other event
Jul 1, 20258-K for Jun 30, 2025: Acquisition or disposal completed; Other event

Proxy statements 3

Other filings 8

Jan 11, 201925-NSE
May 11, 2017424B5
May 9, 2017424B5
Apr 4, 201725-NSE
Mar 9, 2017424B5
Mar 7, 2017424B5
Sep 26, 2014424B3
Sep 17, 2014S-4

Links open the document on SEC EDGAR. Earnings call transcripts are not SEC filings and belong to their publishers, so they are not reproduced here; the press release and slides filed with each results 8-K are.

Rating actions

Jul 27, 2026Moody's: Upgraded to Caa1 from Caa2, outlook stable. Debt paid down with divestiture proceeds lowered leverage even though revenue and EBITDA stayed roughly flat. · source
Jul 28, 2025Fitch: Assigned B / RR2 to the new first-lien notes due 2034. Rating on the new secured notes used to refinance nearer maturities; strong expected recovery puts it above the issuer level. · source
May 2, 2025S&P: Upgraded to CCC+ from SD, outlook negative; 2028 unsecured notes to CCC- from D; new 2033 secured notes rated B-. Rating restored after the discounted 2028 note tender, but leverage near 8x and the risk of more below-par buybacks keep the outlook negative. · source
Apr 30, 2025S&P: Downgraded to SD from CCC+; 6.875% 2028 notes to D from CCC-. S&P treated the tender for the 2028 notes at 75 cents on the dollar as a distressed exchange, the fourth such event in three years. · source

Coming up

Feb 18, 2027Results. Full-year results for the period ending 2026-12-31. The date is an estimate: last year's filing date moved forward a year.
Apr 1, 2028Maturity. 6.875% Senior Notes due 2028: $42mm outstanding comes due.

Recent 8-K filings

Nov 10, 2026Other event
Oct 28, 2026Reported results; Regulation FD disclosure
Jul 22, 2026Reported results; Regulation FD disclosure