Tenet is now two businesses: USPI, a fast growing ambulatory surgery chain that earned about 40% of third quarter 2026 Adjusted EBITDA, and 51 acute care hospitals whose margin rose to 19.2% on volume growth and tight labor cost. Over the next year the credit turns on whether hospital pricing per adjusted admission keeps up as exchange enrollment falls after the enhanced ACA subsidies ended and as the 2025 federal reconciliation law starts to cap Medicaid supplemental payments in 2027, whether salaries per adjusted admission stay near $8,300 to $8,700, and whether USPI keeps adding cases and revenue per case through acquisitions and higher acuity. Cash flow also gets a lift from the first $453mm CommonSpirit note payment in January 2027, while Conifer revenue from CommonSpirit ends after October 2026; net leverage was 2.11x at September 30, 2026 with no secured notes left due before 2028.
Leverage falls from 1.6x to 1.5x over the next four quarters on the starting case.
Free cash flow of $2.74bn is projected over the next year, with no itemised debt due in that time.
Net debt shrinks from $10.57bn to $7.83bn.
Liquidity a year out is $7.31bn, against $4.57bn today.
Company guidance for fiscal 2026: adjusted EBITDA of $5.05bn to $5.20bn on its own definition, free cash flow of $2.83bn to $3.13bn.
Built from the inputs on the Projections tab of the model; change them there. A starting case from history, not a forecast.
Liquidity after maturities and a year of cash flow
$6,052.0
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.
Key Financials
2021A
2022A
2023A
2024A
2025A
LTM
3Q27E LTM
3Q28E LTM
Revenue
$19,485
$19,174
$20,564
$20,675
$21,310
$22,154
$22,289
$22,289
Y/Y Growth
(1.6%)
7.2%
0.5%
3.1%
0.6%
0.0%
Implied Costs
(15,638)
(15,732)
(16,996)
(13,771)
(16,730)
(15,595)
(17,201)
(17,201)
Adj. EBITDA
$3,847
$3,442
$3,568
$6,904
$4,580
$6,559
$5,088
$5,088
Margin
19.7%
18.0%
17.4%
33.4%
21.5%
29.6%
22.8%
22.8%
(-) Restructuring and other cash add-backs
(57)
(118)
(79)
(56)
(44)
(65)
--
--
Cash EBITDA
$3,790
$3,324
$3,489
$6,848
$4,536
$6,494
$5,088
$5,088
(-) Interest Expense (Cash Only)
(937)
(848)
(882)
(851)
(865)
(830)
(818)
(818)
(-) Cash Taxes
(92)
(161)
(243)
(1,271)
(450)
(614)
(614)
(614)
(-) Capex
(658)
(762)
(751)
(931)
(1,010)
(910)
(916)
(916)
(+/-) Working Capital and Other
(1,193)
(1,232)
10
(2,679)
319
(812)
--
--
Memo: FCF
$910
$321
$1,623
$1,116
$2,530
$3,328
$2,740
$2,740
% of Debt
6.9%
2.4%
12.3%
8.4%
19.1%
25.1%
20.7%
20.7%
Key Drivers
Driver
4Q25A
1Q26A
2Q26A
3Q26A
4Q26E
1Q27E
2Q27E
3Q27E
4Q27E
1Q28E
2Q28E
3Q28E
Sensitivity
Next 12m impact ($mm)
Hospital adjusted admissionsthousands per quarter
214.8
215.4
218.2
223.6
219.0
215.4
218.2
223.6
219.0
215.4
218.2
223.6
$16.1mm on revenue
68
Hospital net patient service revenue per adjusted admission$ per adjusted admission
16,517
16,132
16,807
16,062
16,680
16,132
16,807
16,062
16,680
16,132
16,807
16,062
$0.2mm on revenue
36
Hospital salaries, wages and benefits per adjusted admission$ per adjusted admission
8,766
8,565
8,675
8,261
8,450
8,565
8,675
8,261
8,450
8,565
8,675
8,261
$0.2mm on other operating costs
(70)
USPI net patient service revenue per consolidated case$ per case
2,685
2,647
2,569
2,588
2,747
2,647
2,569
2,588
2,747
2,647
2,569
2,588
$0.5mm on revenue
32
Conifer contract termination revenue and transition items$mm per quarter
0
413
413
793
0
0
0
0
0
0
0
0
$-1.0mm on other operating costs
1,619
Tenet is now two businesses: USPI, a fast growing ambulatory surgery chain that earned about 40% of third quarter 2026 Adjusted EBITDA, and 51 acute care hospitals whose margin rose to 19.2% on volume growth and tight labor cost. Over the next year the credit turns on whether hospital pricing per adjusted admission keeps up as exchange enrollment falls after the enhanced ACA subsidies ended and as the 2025 federal reconciliation law starts to cap Medicaid supplemental payments in 2027, whether salaries per adjusted admission stay near $8,300 to $8,700, and whether USPI keeps adding cases and revenue per case through acquisitions and higher acuity. Cash flow also gets a lift from the first $453mm CommonSpirit note payment in January 2027, while Conifer revenue from CommonSpirit ends after October 2026; net leverage was 2.11x at September 30, 2026 with no secured notes left due before 2028.
Bottoms-Up Projections: starting case
$ in millions
4Q25A
1Q26A
2Q26A
3Q26A
4Q26E
1Q27E
2Q27E
3Q27E
4Q27E
1Q28E
2Q28E
3Q28E
Revenue
$5,527
$5,368
$5,628
$5,631
$5,662
$5,368
$5,628
$5,631
$5,662
$5,368
$5,628
$5,631
Y/Y Growth
8.9%
2.8%
6.8%
6.5%
2.4%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Adj. EBITDA
$1,168
$1,571
$1,786
$2,034
$1,315
$1,159
$1,369
$1,245
$1,315
$1,159
$1,369
$1,245
Margin
21.1%
29.3%
31.7%
36.1%
23.2%
21.6%
24.3%
22.1%
23.2%
21.6%
24.3%
22.1%
Free Cash Flow
$367
$1,461
$417
$1,083
$725
$580
$780
$655
$725
$580
$780
$655
Cash, end of period
2,883
2,967
2,170
2,674
3,399
3,979
4,759
5,414
6,138
6,719
7,498
8,153
Total Debt, end of period
13,171
13,209
13,248
13,243
13,243
13,243
13,243
13,243
13,243
13,243
13,243
13,243
Net Debt / Adj. EBITDA
2.2x
2.1x
1.9x
1.6x
1.5x
1.5x
1.4x
1.5x
1.4x
1.3x
1.1x
1.0x
Revenue is built from one revenue line, 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.
Tenet beat its own plan in Q3 2026, raised full-year EBITDA and free cash flow guidance, and pushed out its 2027 secured maturity with a $2.0 billion 2034 note.
Takeaways
Revenue rose 6.5% to $5.63 billion and Adjusted EBITDA rose 23% to $1.355 billion, a 24.1% margin. About $147 million of that came from one-off effects of exiting the CommonSpirit revenue cycle contract at Conifer.
Underlying trends were solid. USPI ambulatory EBITDA grew 9.1% at a 39.2% margin. Hospital adjusted admissions rose 3.2%, but fewer exchange patients hurt payer mix.
Cash generation is strong. Adjusted free cash flow was $2.52 billion for nine months and about $1.1 billion in the quarter.
Net leverage fell to 2.11x EBITDA (2.58x after NCI) from 2.33x at June 30. Cash was $2.67 billion with $1.9 billion undrawn on the revolver.
Conifer transition items add about $450 million of 2026 EBITDA that management says will not recur in 2027, so 2027 comparisons start from a lower base.
Shareholder returns stay large. Buybacks were $255 million in Q3 and $1.615 billion year to date, with $1.88 billion of authorization left.
Debt and capital
On September 22, 2026 Tenet issued $2.0 billion of 6.250% senior unsecured notes due 2034, upsized from a planned $1.5 billion.
Proceeds plus cash redeemed all $1.5 billion of 5.125% first lien secured notes due November 2027 and $500 million of 6.125% senior notes due October 2028.
The company says it has no significant debt maturities until 2028. Long-term debt was $13.08 billion plus $164 million current at September 30, 2026.
The new notes have no debt or restricted payment covenants. They are callable at a make-whole before September 15, 2029.
Capital priorities: about $250 million a year for ambulatory M&A and de novos, hospital investment, buybacks, and keeping the balance sheet deleveraged.
Guidance
FY 2026 Adjusted EBITDA raised to $5.05 to $5.20 billion, up $195 million at the midpoint.
FY 2026 adjusted free cash flow raised to $2.825 to $3.125 billion, up $100 million. This includes a $150 million tax payment tied to the RCM contract termination.
FY 2026 net operating revenues guided to $22.05 to $22.45 billion. Adjusted EPS guided to $22.05 to $23.01.
Segment outlook: Ambulatory EBITDA $2.16 to $2.22 billion and Hospital EBITDA $2.89 to $2.98 billion. Capex held at $700 to $800 million.
Q4 2026 will reverse the Q3 timing benefit, with $233 million less contract termination revenue and $97 million less net revenue, partly offset by about $110 million of further transition benefits.
Tone: Confident and upbeat, with management stressing margin strength, free cash flow and a cleaner maturity profile while flagging the non-recurring Conifer benefit.
Summary written with AI from Press release, slide presentation and related 8-K filings. Tenet does not publish a 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
Tenet raised its 2026 outlook again after third-quarter Adjusted EBITDA rose 23% to $1.36bn, including $147mm of Conifer transition benefits.
Results
Net operating revenues were $5.63bn, up 6.5% from $5.29bn a year earlier. Separately, the company booked $646mm of revenue from contract termination tied to Conifer, which it excludes from net operating revenues and Adjusted EBITDA.
Adjusted EBITDA was $1.355bn versus $1.099bn, and the margin rose to 24.1% from 20.8%. The quarter includes a $147mm net favorable impact from the faster Conifer revenue cycle transition ($97mm timing catch-up in revenue plus about $50mm of transition benefits).
Ambulatory (USPI) Adjusted EBITDA was $537mm, up 9.1%, at a 39.2% margin. Hospital Adjusted EBITDA was $818mm, up from $607mm, at a 19.2% margin.
Adjusted free cash flow was $1.102bn in the quarter on $198mm of capex. Reported free cash flow was $1.083bn.
Net income available to common shareholders was $1.0bn, or $12.41 per diluted share, lifted by the contract termination revenue.
Why
Hospital same-hospital adjusted admissions rose 3.2% and ER visits rose 4.0%, but revenue per adjusted admission rose only 0.2% as fewer exchange admissions weighed on payer mix.
USPI same-facility system-wide revenue rose 4.5%, with revenue per case up 6.1% on higher acuity and cases down 1.5%.
Salaries, wages and benefits fell 1.4% year over year while revenue grew, which the company credits to expense discipline.
The Hospital segment also recognized $32mm of prior-year Medicaid supplemental revenue, versus $38mm in the same quarter of 2025.
Balance sheet and guidance
Cash was $2.674bn and total debt was about $13.24bn ($164mm current plus $13.079bn long-term) at September 30, 2026. The release does not give revolver availability or total liquidity.
Net debt to Adjusted EBITDA was 2.11x, down from 2.33x at June 30, 2026 and 2.25x at year-end 2025.
In September the company issued $2.0bn of 6.250% senior notes due 2034 and used the proceeds with cash to redeem all $1.5bn of 5.125% first lien notes due 2027 and $500mm of 6.125% senior notes due 2028. It also bought back $255mm of stock in the quarter and $1.615bn year to date.
FY 2026 Adjusted EBITDA raised to $5.05bn to $5.20bn, from $4.83bn to $5.03bn in the second-quarter release.
FY 2026 net operating revenues narrowed to $22.05bn to $22.45bn, from $21.9bn to $22.5bn; the midpoint is unchanged.
FY 2026 Adjusted free cash flow raised to $2.825bn to $3.125bn, from $2.725bn to $3.025bn. Reported free cash flow is now $3.185bn to $3.515bn.
FY 2026 capex held at $700mm to $800mm. Hospital segment Adjusted EBITDA raised to $2.89bn to $2.98bn; Ambulatory held at $2.16bn to $2.22bn.
What to watch
Fourth-quarter run rate after Conifer: the CommonSpirit revenue cycle work was to be substantially transitioned by October 30, 2026, so the $147mm third-quarter benefit and contract termination revenue should not repeat. The full-year range implies fourth-quarter Adjusted EBITDA of about $1.23bn to $1.38bn.
Payer mix: lower exchange admissions held hospital revenue per adjusted admission to 0.2% growth, and USPI surgical cases fell 1.5%, so volume and mix matter more as one-time items fall away.
Capital allocation versus leverage: $1.615bn of buybacks and $583mm of noncontrolling interest purchases year to date, with $2.13bn of authorization reported in July, against net leverage of 2.11x and the remaining 6.125% notes due 2028.
From the company's press release filed Oct 29, 2026. Figures in this section are as the company reports them, including its own adjusted EBITDA.
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.
Coming up
Feb 16, 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.
Jun 15, 2028Maturity. 4.625% Senior Secured First Lien Notes due 2028: $600mm outstanding comes due.
Oct 1, 2028Maturity. 6.125% Senior Notes due 2028: $1,250mm outstanding comes due.