HCA Healthcare, Community Health Systems, Tenet Healthcare and Universal Health Services are among the largest for-profit health systems in the country. Each system has a unique backstory and commands an extensive network of hospitals and physicians.
Here are 67 things to know about each health system, including financial performance, recent transactions, leadership, system size, history and executive compensation:
Financial performance
HCA Healthcare (Nashville, Tenn.)
1. HCA reported $5.2 billion in net income in 2023, down 7% from $5.6 billion in 2022. Operating income was $7.7 billion, down from $8.6 billion the previous year.
2. Revenue for the year totaled $65 billion, up from $60 billion in 2022.
3. In 2024, HCA expects revenues between $69.75 billion and $71.75 billion and net income of $5.2 billion to $5.6 billion. Capital expenditures, excluding acquisitions, are projected to be between $5.1 billion and $5.3 billion.
Tenet Healthcare (Dallas)
4. Tenet reported $1.3 billion in net income in 2023, up 30% from $1 billion in 2022. Operating income hit $2.5 billion, growing 12.2% year over year.
5. Revenue for the year totaled $20.5 billion, up from $19.2 billion in 2022.
6. In 2024, Tenet expects revenues between $20.6 billion and $20.8 billion and adjusted EBITDA in the range of $3.9 billion to $4 billion.
Community Health Systems (Franklin, Tenn.)
7. CHS reported a net income of $16 million in 2023, down from $179 million in 2022. Operating income was $957 million for the year, improving on the $821 million posted in 2022.
8. Revenue increased 2.3% year over year to $12.5 billion in 2023.
9. In 2024, CHS expects net operating revenues between $12.3 billion and $12.7 billion. Adjusted EBITDA is projected to be in the range of $1.48 billion to $1.63 billion.
Universal Health Services (King of Prussia, Pa.)
10. UHS posted $719.3 million in net income in 2023, compared to $656.9 million the previous year. Operating income was $1.2 billion, up from $1 billion.
11. The system saw overall revenue increase 6.6% year over year to $14.3 billion.
12. In 2024, the health system expects net revenues to be between $15.4 billion and $15.7 billion, representing an increase of 7.9% to 10% year over year. UHS is projected to spend $1 billion on capital expenses this year, up from $850 million in 2023.
Hospital acquisitions and sales
HCA
13. Medical City Healthcare in Dallas, a subsidiary of HCA, acquired Trinity Regional Hospital Sachse (Texas) from Sunland Medical Foundation Feb. 1.
14. HCA sold West Hills Hospital and Medical Center, a 260-bed hospital, to Los Angeles-based in March.
15. In July, Catholic Medical Center, a 330-bed regional health system in Manchester, N.H., entered into an asset purchase agreement with a subsidiary of HCA and initiated the regulatory review process with the New Hampshire Attorney General's Office.
16. HCA plans to sell Regional Medical Center in San Jose, Calif., to Santa Clara County. The $175 million deal is expected to be completed in the first quarter of 2025, pending regulatory approvals and closing conditions.
17. HCA plans to sell Terre Haute (Ind.) Regional Hospital, a 278-bed facility, to Union Health, which is headquartered in Terre Haute. In November, Union Health withdrew its certificate of public advantage agreement for the deal amid potential antitrust concerns raised by the Federal Trade Commission. However, Union Health said it plans to resubmit the COPA application.
18. HCA entered into an asset purchase agreement on Oct. 3 to buy Lehigh Regional Medical Center, a 53-bed hospital in Lehigh Acres, Fla., from Ontario, Calif.-based Prime Healthcare. The deal is expected to close Jan. 18, pending regulatory approvals and closing conditions.
Tenet
19. Tenetsold its 70% majority ownership interest in Birmingham, Ala.-based Brookwood Baptist Health to Orlando (Fla.) Health in October. The sale comprises five hospitals:
- Brookwood Baptist Medical Center (Birmingham, Ala.)
- Princeton Baptist Medical Center (Birmingham, Ala.)
- Walker Baptist Medical Center (Jasper, Ala.)
- Shelby Baptist Medical Center (Alabaster, Ala.)
- Citizens Baptist Medical Center (Talladega, Ala.)
20. Tenet sold three South Carolina hospitals to Winston-Salem, N.C.-based Novant Health for $2.4 billion, effective Feb. 1. The hospitals include East Cooper Medical Center in Mount Pleasant, Hilton Head Hospital and Coastal Carolina Hospital in Hardeeville.
22. In March, Tenet completed the $975 million sale of four Southern California hospitals to Orange, Calif.-based UCI Health. The hospitals included in the transaction were: Fountain Valley Regional Hospital, Lakewood Regional Medical Center, Los Alamitos Medical Center and Placentia-Linda Hospital.
23. In March, Tenet sold two hospitals — Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton — to Roseville, Calif.-based Adventist Health for $550 million.
CHS
24. On Oct. 1, CHS sold Davis Regional Psychiatric Hospital and Davis Regional Medical Center in Statesville, N.C., to Iredell Health System. Iredell aims to keep the 42-bed behavioral health facility open and expand services at the acute care hospital. Financial terms of the deal were not disclosed.
25. CHS on Aug. 1 sold Tennova Healthcare-Cleveland (Tenn.) to Vitruvian Health in Dalton, Ga. Vitruvian, which rebranded from Hamilton Health Care System as part of its regional expansion plans, acquired the 351-bed for $160 million. CHS may receive an additional cash payment based on potential changes to certain supplemental reimbursement programs.
26. CHS plans to sell Merit Health Biloxi (Miss.), a 153-bed acute care hospital, to Gulfport, Miss.-based Memorial Health System. Memorial Health is a two-hospital system that has collaborated with Merit Health Biloxi across various service lines. Financial terms of the deal — which is expected to close in the first quarter — have not been disclosed.
27. CHS signed a definitive agreement in August to sell its three Pennsylvania hospitals to nonprofit WoodBridge Healthcare. The proposed $120 million deal would have seen CHS exit Pennsylvania but the deal collapsed in November. CHS said it is evaluating other options for the three-hospital system, Commonwealth Health.
28. In November, CHA entered into a definitive agreement to sell ShorePoint Health Port Charlotte (Fla.) and certain assets of ShorePoint Health Punta Gorda to Altamonte Springs, Fla.-based AdventHealth. The $265 million transaction is expected to close in the first quarter of 2025, pending regulatory approvals and closing conditions.
29. CHS signed a definitive agreement in November to sell Lake Norman Regional Medical Center in Mooresville, N.C., to Durham, N.C.-based Duke University Health System. Duke plans to acquire the 123-bed hospital for $280 million.
UHS
30. UHS in September sold River Crest Hospital, an 80-bed behavioral health hospital, to Shannon Medical Center in San Angelo, Texas.
History/system size
HCA
31. HCA was founded in 1968 by Thomas Frist Sr., MD, Thomas Frist Jr., MD, and Jack Massey. Dr. Frist Sr., who was the father of former U.S. Senate majority leader Bill Frist, built Park View Hospital in Nashville with a group of physicians. They wanted to manage and expand the hospital, eventually creating the hospital management company known as HCA.
32. HCA comprises 187 hospitals and more than 2,300 care sites in 20 states and the United Kingdom.
33. The system's care sites include ASCs — of which it operates about 150 — freestanding ERs, urgent care centers, diagnostic and imaging centers, walk-in clinics and physician clinics.
34. HCA has more than 270,000 employees, including 94,000 registered nurses and 38,000 active physicians
Tenet
35. Tenet launched as a small operation in California. In May 1969, it acquired four hospitals along with some additional care sites and real estate for future hospital developments.
36. The system operates 46 acute care and specialty hospitals, about 110 other outpatient facilities, a network of employed physicians and a global business center in Manila, Philippines.
37. United Surgical Partners International, Tenet's ambulatory arm, operates or has ownership interests in more than 465 ASCs — the most of any health system — and 24 surgical hospitals. USPI aims to have ownership interest in and operate 575 to 600 ASCs by the end of 2025. It also operates Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices and employers.
38. Tenet has more than 100,000 employees and 6,000 physicians.
CHS
39. CHS was founded in 1985 when Thomas Chaney, former executive of Hospital Affiliates, Inc., and David Steffy and Richard Ragsdale, former HCA executives, spun off Republic Health Corp. to form Community Health Systems. The second hospital acquisition took place in January 1986.
40. The system operates 70 acute care hospitals with about 13,000 beds and more than 1,000 care sites, across 15 states. Its healthcare portfolio includes physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ASCs.
41. In 2014, CHS had approximately 200 hospitals. In 2016, CHS began refining its portfolio with the spinoff of Brentwood, Tenn.-based Quorum Health, which included 38 hospitals and its hospital management and consulting business. Over the next several years, CHS sold or closed dozens of hospitals.
42. CHS has more than 90,000 employees and 20,000 physicians — employed and independent — serving on the medical staff of its hospitals.
UHS
43. UHS was founded in 1979 by Alan B. Miller, who currently serves as the system's executive chair. Eighteen months later, UHS owned four hospitals and had management contracts with two others.
44. The system operates 27 acute care hospitals, 334 behavioral health inpatient facilities, 22 freestanding emergency departments and 49 outpatient facilities and ambulatory care centers in 39 states in the U.S., Washington, D.C., Puerto Rico and the United Kingdom.
45. UHS also offers health insurance plans through Prominence Health Plan, and manages a network of physicians through Independence Physician Management.
56. UHS has about 94,000 employees —- 34,000 of whom operate at its acute care facilities and 55,000 of whom are focused on behavioral health. It also has 12 physician networks comprising more than 700 providers.
Leadership
HCA
47. Sam Hazen was appointed CEO of HCA in January 2019 after serving as president and COO since 2016.
2. Mr. Hazen is a 40-year veteran of HCA, and has held various senior positions for the health system, including president of operations from 2011 to 2015.
48. He also served as president of HCA's Western Group, which included all operations west of the Mississippi River and represented about 50 percent of the system's revenue.
49. Mr. Hazen began his career in Humana's financial management specialist program in 1983 and has held CFO positions at hospitals in Georgia and Las Vegas.
Tenet
50. Saum Sutaria, MD, was appointed CEO of Tenet in September 2021 and elected board chair in August 2023.
51. Dr. Sutaria previously served as president and COO of Tenet with responsibilities spanning the enterprise.
52. He joined the for-profit system in 2019 after working for nearly two decades at McKinsey & Company. At McKinsey, Dr. Sutaria was a leader in the healthcare and private equity practices, advising clients on strategic, operational and financial matters.
53. Dr. Sutaria previously held an associate clinical faculty appointment at the University of California at San Francisco, where he also engaged in postgraduate training with a focus in internal medicine and cardiology.
CHS
54. Tim Hingtgen was named CEO of CHS in January 2021 after serving as president and COO from September 2016 through December 2020.
55. Mr. Hingtgen, who also serves on the board, joined CHS as a vice president of operations in 2008. In January 2014, he was promoted to president of division IV operations, and in May 2016, he was promoted to executive vice president of operations.
56. Before joining CHS, Mr. Hingtgen served as a CEO or COO of hospitals affiliated with UHS and Brentwood, Tenn.-based Province Healthcare.
57. Mr. Hingtgen has a master's degree in business administration from the University of Nevada, Las Vegas.
UHS
58. Marc Miller was named CEO of UHS in January 2021 and has served as president since 2009.
59. Mr. Miller is also a member of the UHS board, serving on the executive committee and the finance committee.
60. He began his career at UHS in 1995 and has held multiple positions of increasing responsibility at hospitals and at the corporate office. Before stepping into executive leadership roles at, he held various operating roles at UHS acute care hospitals.
61. Mr. Miller's prior executive roles include group director for the health system's acute care operations in Pennsylvania, South Carolina and Florida; Eastern region vice president of the acute care division; and senior vice president and co-head of the UHS acute care division.
Executive compensation
62. The CEOs and CFOs of all four health systems saw compensation packages drop substantially in 2022, according to proxy statements filed with the SEC. However, most of the top-earning executives saw their overall compensation rebound in 2023 as financial results largely improved.
63. The CEOs of the four systems earned compensation packages of more than $63 million combined in 2023, compared to about $43 million in 2022 and $65 million in 2021.
64. The five highest-earning executives at HCA in 2023 were:
- Sam Hazen, CEO: $21,315,984
- Jon Foster, EVP and COO: $8,699,360
- Bill Rutherford, former EVP and CFO: $7,763,050
- Timothy McManus, president, national group: $5,582,431
- Erol Akdamar, president, American group: $5,400,861
65. The five highest-earning executives at Tenet in 2023 were:
- Saum Sutaria, MD, CEO: $18,518,109
- Dan Cancelmi, CFO: $9,272,504
- Tom Arnst, EVP, chief administrative officer, general counsel and corporate secretary: $3,672,298
- Lisa Foo, EVP, commercial operations: $3,235,506
- Paola Arbour, EVP, chief information officer: $2,467,441
66. The five highest-earning executives at CHS in 2023 were:
- Tim Hingtgen, CEO:$8,348,223
- Kevin Hammons, President and CFO: $3,750,006
- Lynn Simon, MD, president of clinical operations and chief medical officer:
$2,144,471 - Chad Campbell, regional president: $1,657,282
- Kevin Stockton, EVP of operations and development: $1,602,702
67. The five highest-earning executives at UHS in 2023 were:
- Marc Miller, CEO and president: $14,407,937
- Alan Miller, executive chair: $8,369,731
- Edward Sim, EVP and president of acute care: $5,469,137
- Steve Filton, EVP and CFO: $4,650,157
- Matthew Peterson, EVP and president of behavioral health: $4,049,604
Editor's note: Total compensation can include salary, bonuses, stock and option awards, change in pension value and nonqualified deferred compensation earnings and other compensation.