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Ardent Health Reports Fourth Quarter 2025 Results

Ardent Health, Inc. (NYSE: ARDT) ("Ardent Health" or the "Company"), a leading provider of healthcare in growing mid-sized urban communities across the U.S., today announced results for the quarter ended December 31, 2025.

Fourth Quarter 2025 Operating and Financial Summary

All comparisons are versus the same prior year period. See the footnotes to the Operating Statistics table of this press release for definitions of the metrics below and a full list of key operating metrics.

Total Revenue

4Q25: $1.61 billion

2025: $6.32 billion; 6.0% growth Y/Y

Net Income Attributable to Ardent Health

4Q25: $45 million

Adjusted EBITDA(1)

4Q25: $134 million

2025: $545 million; 9.3% growth Y/Y

Adjusted EBITDAR(1)

4Q25: $176 million

Admissions

4Q25: 1.5% growth Y/Y

Adjusted Admissions

4Q25: 2.0% growth Y/Y

Operating Cash Flow

4Q25: $223 million

87% growth Y/Y

Issuing Full-Year 2026 Guidance

Total Revenue: $6,400 - $6,700 million

Adjusted EBITDA(1): $485 - $535 million

(1)

Adjusted EBITDA and Adjusted EBITDAR are financial measures that have not been prepared in a manner that complies with U.S. generally accepted accounting principles ("GAAP"). See "Supplemental Non-GAAP Financial Information" and reconciliations of non-GAAP measures to their most comparable GAAP financial measures contained later in this press release.

Solid Finish to 2025: IMPACT Program Building Momentum; Robust Cash Flow Generation

  • "I'm pleased with tangible progress from the deliberate, measurable actions we took during the fourth quarter to mitigate the payor denial and professional fee industry pressures we outlined on the third quarter earnings call," stated Marty Bonick, President and Chief Executive Officer of Ardent Health. "Disciplined execution and expense optimization drove solid fourth quarter adjusted EBITDA results. Our IMPACT program is building traction and resulted in significant SWB expense improvements, particularly in contract labor. Additionally, I'm encouraged by payor denial and professional fee dynamics that were stable in the fourth quarter."
  • "The solid finish to the year resulted in 2025 revenue and adjusted EBITDA growth of 6% and 9%, respectively, with adjusted EBITDA margins expanding 20 basis points," added Bonick. "Furthermore, we generated robust operating cash flow of $471 million in 2025, up nearly 50%. We also strengthened our balance sheet by improving net leverage to 2.5x and growing cash to over $700 million at year-end."
  • "We enter 2026 with improving momentum from our IMPACT program, which we now expect to generate $55 million of savings this year, up from $40 million previously. We are highly focused on optimizing revenue, disciplined expense management, and productivity, all while delivering superior quality," continued Bonick. "At the same time, we are stepping over annualization of the aforementioned industry headwinds and the expiration of enhanced Exchange subsidies. As such, we are taking a prudent approach to establishing our 2026 adjusted EBITDA guidance of $485-$535 million."
  • "We remain confident in our ability to deliver long-term shareholder value,” stated Bonick. "We expect to return to adjusted EBITDA growth in 2027, and over the longer-term our business is strategically well-positioned to leverage key pillars including: durable demand, operational efficiencies captured by our IMPACT program, and capital deployment supported by our strong balance sheet."

Financial Performance Summary

Fourth quarter 2025 year-over-year growth rates were negatively impacted by the Company recording two quarters of financial benefit from the New Mexico state directed payment program in the prior year quarter.

For the fourth quarter of 2025:

  • Total revenue decreased 0.1% year-over-year to $1,605 million, driven primarily by a 2.0% increase in adjusted admissions offset by a 2.4% decrease in net patient service revenue per adjusted admission. Total revenue increased approximately 3% year-over-year when adjusting for the New Mexico state directed payment program that included two quarters of financial benefit in the prior year quarter.
  • Net income attributable to Ardent Health was $45 million, or $0.32 per diluted share, compared to net income attributable to Ardent Health of $114 million, or $0.81 per diluted share, in the fourth quarter of 2024.
  • Adjusted EBITDA decreased 26.6% year-over-year to $134 million.

For the full-year 2025, revenue increased 6.0% to $6.32 billion, Adjusted EBITDA grew 9.3% to $545 million, and Adjusted EBITDA margin expanded 20bps to 8.6%.

Operating Performance Summary

The following table provides a summary of certain key operating metrics for the fourth quarter of 2025 compared to the same prior year period. See the footnotes to the Operating Statistics table of this press release for definitions of the metrics below and a full list of key operating metrics.

 

Three Months Ended December 31,

(Unaudited)

2025

 

2024

 

% Change

Adjusted admissions

 

88,583

 

 

86,872

 

2.0

%

Admissions

 

40,896

 

 

40,300

 

1.5

%

Inpatient surgeries

 

9,466

 

 

9,108

 

3.9

%

Outpatient surgeries

 

23,976

 

 

24,296

 

(1.3

%)

Total surgeries

 

33,442

 

 

33,404

 

0.1

%

Emergency room visits

 

158,256

 

 

161,010

 

(1.7

%)

Net patient service revenue per adjusted admission

$

17,757

 

$

18,200

 

(2.4

%)

  • Admissions for the fourth quarter of 2025 increased 1.5% year-over-year, driven by strong inpatient surgery growth.
  • Surgeries for the fourth quarter of 2025 increased 0.1% year-over-year. The increase in total surgeries reflected inpatient surgery growth of 3.9% largely offset by a decrease in outpatient surgeries of 1.3%.

Balance Sheet, Cash Flow & Liquidity Update

As of December 31, 2025, the Company had total cash and cash equivalents of $710 million and total debt of $1.1 billion. The Company’s net leverage ratio as of December 31, 2025, was 0.8x, as calculated under the Company's credit agreements, and its lease-adjusted net leverage ratio1 was 2.5x, an improvement from 2.9x as of December 31, 2024. At the end of the fourth quarter, the Company’s available liquidity was $1 billion.

During the fourth quarter of 2025, net cash provided by operating activities was $223 million, compared to $120 million in the same prior year period. For the full-year 2025, net cash provided by operating activities increased 49% to $471 million.

During the fourth quarter of 2025, the Company repurchased 0.35 million shares of its common stock for $3 million. The Company had $47 million remaining under its repurchase authorization as of December 31, 2025.

____________________

1

Lease-adjusted net leverage ratio is defined as the Company's net debt as of December 31, 2025, plus 8x trailing twelve-month real estate investment trust ("REIT") rent expense as of the end of the fourth quarter of 2025, divided by trailing twelve-month Adjusted EBITDAR as of December 31, 2025.

Introducing 2026 Financial Guidance

The Company is providing initial full-year 2026 financial guidance. The guidance incorporates a number of assumptions, including headwinds from annualization of elevated professional fees and other rate pressures driven by payor denials, Exchange disruption, and restoration of short-term compensation. The outlook also assumes tailwinds from mid-single digit core earnings growth and IMPACT program savings. All guidance is current as of the time provided and is subject to change.

(Unaudited; dollars in millions, except per share amount)

Full Year 2026 Guidance

Total revenue

$6,400

$6,700

Net income attributable to Ardent Health, Inc.

$129

$183

Adjusted EBITDA

$485

$535

Rent expense payable to REITs

$168

$168

Diluted earnings per share

$0.90

$1.27

Adjusted admissions growth

1.5%

2.5%

Capital expenditures

$225

$265

The Company’s guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below under the heading "Forward-Looking Statements." The Company does not forecast the impact of items such as, but not limited to, losses (gains) on sales of facilities, losses on retirement of debt, legal claim costs (benefits) and impairments of long-lived assets. The Company does not believe that it can forecast these items with sufficient accuracy because of the inherent difficulty of forecasting the timing or amount of various items that have not yet occurred and are out of the Company’s control or cannot be reasonably predicted.

Fourth Quarter and Year End 2025 Results Conference Call

The Company will host a conference call to discuss its fourth quarter and year end financial results on March 5, 2026, at 10:00 a.m. Eastern Time. A webcast of the conference call will be available in the Investor Relations section of the Company’s corporate website at https://ir.ardenthealth.com. To listen to a live broadcast, go to the site at least 15 minutes prior to the scheduled start time in order to register, download, and install any necessary audio software.

To participate in the live teleconference:

United States Live:

1-888-596-4144

International Live:

1-646-968-2525

Access Code:

4437657

 

 

To listen to a replay of the teleconference, which will be available through March 19, 2026:

United States Replay:

1-800-770-2030

International Replay:

1-647-362-9199

Access Code:

4437657

About Ardent Health

Ardent Health (NYSE: ARDT) is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, the Company delivers care through a system of 30 acute care hospitals, more than 280 sites of care, and over 2,000 employed and affiliated providers across six states. For more information, please visit ardenthealth.com.

Supplemental Non-GAAP Financial Information

We have included certain non-GAAP financial measures in this press release, including Adjusted EBITDA, Adjusted EBITDA margin, and Adjusted EBITDAR. We define these terms as follows:

  • Adjusted EBITDA and Adjusted EBITDA Margin. Adjusted EBITDA is defined as net income plus (i) provision for income taxes, (ii) interest expense and (iii) depreciation and amortization expense (or EBITDA), as adjusted to deduct noncontrolling interest earnings, and excludes the effects of loss on extinguishment and modification of debt; other non-operating (gains) losses; recoveries from the cybersecurity incident in November 2023 (the "Cybersecurity Incident"), net of incremental information technology and litigation costs; certain legal matters and related costs; restructuring, exit and acquisition-related costs; change in accounting estimate; New Mexico professional liability accrual; expenses incurred in connection with the implementation of our integrated health information technology system provided by Epic Systems; equity-based compensation expense; and loss (income) from disposed operations. Adjusted EBITDA margin is defined as Adjusted EBITDA divided by total revenue.

    Adjusted EBITDA and Adjusted EBITDA margin are non-GAAP performance measures used by our management and external users of our financial statements, such as investors, analysts, lenders, rating agencies and other interested parties, to evaluate companies in our industry. Adjusted EBITDA and Adjusted EBITDA margin are performance measures that are not prepared in accordance with GAAP and are presented in this press release because our management considers them important analytical indicators commonly used within the healthcare industry to evaluate financial performance and allocate resources. Further, our management believes that Adjusted EBITDA and Adjusted EBITDA margin are useful financial metrics to assess our operating performance from period to period by excluding certain material non-cash items and unusual or non-recurring items that we do not expect to continue in the future and certain other adjustments we believe are not reflective of our ongoing operations and our performance.

    Because not all companies use identical calculations, our presentation of Adjusted EBITDA and Adjusted EBITDA margin may not be comparable to other similarly titled measures of other companies. While we believe these are useful supplemental performance measures for investors and other users of our financial information, you should not consider Adjusted EBITDA and Adjusted EBITDA margin in isolation or as a substitute for net income or any other items calculated in accordance with GAAP. Adjusted EBITDA and Adjusted EBITDA margin have inherent material limitations as performance measures, because they add back certain expenses to net income, resulting in those expenses not being taken into account in the performance measures. We have borrowed money, so interest expense is a necessary element of our costs. Because we have material capital and intangible assets, depreciation and amortization expense are necessary elements of our costs. Likewise, the payment of taxes is a necessary element of our operations. Because Adjusted EBITDA and Adjusted EBITDA margin exclude these and other items, they have material limitations as measures of our performance.

  • Adjusted EBITDAR. Adjusted EBITDAR is defined as Adjusted EBITDA further adjusted to add back rent expense payable to real estate investment trusts ("REITs"), which consists of rent expense pursuant to the master lease agreement (the "Ventas Master Lease") with Ventas, Inc. ("Ventas"), lease agreements with Ventas for 18 medical office buildings and a lease arrangement with Medical Properties Trust, Inc. ("MPT") for the Hackensack Meridian Mountainside Medical Center.

    Adjusted EBITDAR is a commonly used non-GAAP valuation measure used by our management, research analysts, investors and other interested parties to evaluate and compare the enterprise value of different companies in our industry. Adjusted EBITDAR excludes: (1) certain material noncash items and unusual or non-recurring items that we do not expect to continue in the future; (2) certain other adjustments that do not impact our enterprise value; and (3) rent expense payable to our REITs. We operate 30 acute care hospitals, 12 of which we lease from two REITs, Ventas and MPT, pursuant to long-term lease agreements. Additionally, we lease 18 medical office buildings from Ventas pursuant to lease agreements with initial terms of 12 years and eight options to renew for additional five-year terms. Our management views the long-term lease agreements with Ventas and MPT, as more like financing arrangements than true operating leases, with the rent payable to such REITs being similar to interest expense. As a result, our capital structure is different than many of our competitors, especially those whose real estate portfolio is predominately owned and not leased. Excluding the rent payable to such REITs allows investors to compare our enterprise value to those of other healthcare companies without regard to differences in capital structures, leasing arrangements and geographic markets, which can vary significantly among companies. Our management also uses Adjusted EBITDAR as one measure in determining the value of prospective acquisitions or divestitures. Finally, financial covenants in certain of our lease agreements, including the Ventas Master Lease, use Adjusted EBITDAR as a measure of compliance. Adjusted EBITDAR does not reflect our cash requirements for leasing commitments. As such, our presentation of Adjusted EBITDAR should not be construed as a performance or liquidity measure.

    Because not all companies use identical calculations, our presentation of Adjusted EBITDAR may not be comparable to other similarly titled measures of other companies. While we believe this is a useful supplemental valuation measure for investors and other users of our financial information, you should not consider Adjusted EBITDAR in isolation or as a substitute for net income or any other items calculated in accordance with GAAP. Adjusted EBITDAR has inherent material limitations as a valuation measure, because it adds back certain expenses to net income, resulting in those expenses not being taken into account in the valuation measure. The payment of taxes and rent is a necessary element of our valuation. Because Adjusted EBITDAR excludes these and other items, it has material limitations as a measure of our valuation.

Forward-Looking Statements

This press release may contain "forward-looking statements," as that term is defined in the U.S. federal securities laws. These forward-looking statements include, but are not limited to, statements other than statements of historical facts, including, among others, statements relating to our future financial performance, our business prospects and strategy, anticipated financial position, liquidity and capital needs, the industry in which we operate and other similar matters. Words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "could," "would," "will," "may," "can," "continue," "potential," "should" and the negative of these terms or other comparable terminology often identify forward-looking statements. When reviewing this press release, you should keep in mind the risks and uncertainties that could impact our business. These forward-looking statements are not guarantees of future performance and are subject to risks and uncertainties that could cause actual results to differ materially from the results contemplated by the forward-looking statements. These risks and uncertainties could cause actual results to differ materially from those projected in forward-looking statements contained in this press release or implied by past results and trends. Our historical results are not necessarily indicative of the results that may be expected for any period in the future. Factors, risks, and uncertainties that could cause actual outcomes and results to be materially different from those contemplated include, among others: (1) general economic and business conditions, both nationally and in the regions in which we operate, including the impact of challenging macroeconomic conditions and inflationary pressures, current geopolitical instability, and impacts from the imposition of, or changes in, tariffs, as well as the potential impact on us of the federal government shutdown or other uncertain political, financial, credit and capital conditions; (2) possible reductions or other changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs, Medicaid waiver programs or state directed payments, that could have an adverse effect on our revenues and business; (3) reduction in the reimbursement rates paid by commercial payors, increased reimbursement denials or payment delays by commercial payors, our inability to retain and negotiate favorable contracts with private third party payors, or an increasing volume of uninsured or underinsured patients; (4) effects of changes in healthcare policy or legislation, including the One Big Beautiful Bill Act (the "OBBBA") and any other reforms that have or may be undertaken by the current presidential administration, and legal and regulatory restrictions on our hospitals that have physician owners; (5) the ability to achieve operating and financial targets, develop and execute mitigation plans to offset to the extent possible impacts from the OBBBA, the expiration of temporary enhanced subsidies for individuals eligible to purchase insurance coverage through health insurance marketplaces and imposition of tariffs, attain expected levels of patient volumes and revenues, and control the costs of providing services; (6) security threats, catastrophic events and other disruptions affecting our, our service providers’ or our joint venture ("JV") partners’ information technology and related systems, which have adversely affected, and could in the future adversely affect, our relationships with patients and business partners and subject us to legal claims and liabilities, reputational harm and business disruption and adversely affect our financial condition; (7) the highly competitive nature of the healthcare industry and continued industry trends towards clinical transparency and value-based purchasing may impact our competitive position; (8) inability to recruit and retain quality physicians, as well as increasing cost to contract with hospital-based physicians; (9) changes to physician utilization practices and treatment methodologies and other factors outside our control that impact demand for medical services and may reduce our revenues and ability to grow profitability; (10) continued industry trends toward value-based purchasing, third party payor consolidation and care coordination among healthcare providers; (11) inability to successfully complete acquisitions or strategic JVs or inability to realize all of the anticipated benefits; (12) liabilities because of professional liability and other claims brought against our hospitals, physician practices, outpatient facilities or other business operations; (13) exposure to certain risks and uncertainties by the JVs through which we conduct a significant portion of our operations, including anticipated synergies of past acquisitions and the risk that transactions may not receive necessary government clearances; (14) failure to obtain drugs and medical supplies at favorable prices or sufficient volumes; (15) operational, legal and financial risks associated with outsourcing functions to third parties; (16) our facilities are heavily concentrated in Texas and Oklahoma, which makes us sensitive to regulatory, economic and competitive conditions and changes in those states; (17) negative impact of severe weather, climate change, and other factors beyond our control, which could restrict patient access to care or cause one or more facilities to close temporarily or permanently; (18) risks related to the Master Lease with Ventas (“Ventas Master Lease”) and its restrictions and limitations on our business; (19) the impact of our significant indebtedness and the ability to refinance such indebtedness on acceptable terms; (20) our failure to comply with complex laws and regulations applicable to the healthcare industry or to adjust our operations in response to changing laws and regulations; (21) the impact of governmental claims or governmental investigations, payor audits and litigation brought against our hospitals, physician practices, outpatient facilities or other business operations; (22) actual or perceived failures to comply with applicable data protection, privacy and security laws, regulations, standards and other requirements; (23) the impact of a deterioration of public health conditions associated with a future pandemic, epidemic or outbreak of infectious disease; (24) inability to or delay in building, acquiring, selling, renovating or expanding our healthcare facilities; (25) failure to comply with federal and state laws relating to Medicare and Medicaid enrollment, permit, licensing and accreditation requirements; (26) the results of our efforts to use technology, including artificial intelligence (“AI”) and machine learning, to drive efficiencies, better outcomes and an enhanced patient experience; (27) our status as a controlled company; (28) conflicts of interest between our controlling stockholder and other holders of our common stock; and (29) other risk factors described in our filings with the Securities and Exchange Commission.

Many of the important factors that will determine these results are beyond our ability to control or predict. You are cautioned not to put undue reliance on any forward-looking statements, which speak only as of the date of this press release. Except as otherwise required by law, we do not assume any obligation to publicly update or release any revisions to these forward-looking statements to reflect events or circumstances after the date of this news release or to reflect the occurrence of unanticipated events. All references to "Company," "Ardent Health," "Ardent," "we," "our" and "us" as used throughout this release refer to Ardent Health, Inc. and its affiliates, unless stated otherwise or indicated by context.

Ardent Health, Inc.

Consolidated Income Statements

(Unaudited; dollars in thousands, except per share amounts)

 

 

Three Months Ended December 31,

 

2025

 

2024

 

Amount

 

%

 

Amount

 

%

Total revenue

$

1,605,079

 

100.0

%

 

$

1,606,289

 

 

100.0

%

Expenses:

 

 

 

 

 

 

 

Salaries and benefits

 

651,389

 

40.6

%

 

 

653,966

 

 

40.7

%

Professional fees

 

309,693

 

19.3

%

 

 

286,299

 

 

17.8

%

Supplies

 

277,533

 

17.3

%

 

 

264,088

 

 

16.4

%

Rents and leases

 

27,614

 

1.7

%

 

 

27,326

 

 

1.7

%

Rents and leases, related party

 

38,930

 

2.4

%

 

 

37,816

 

 

2.4

%

Other operating expenses

 

154,129

 

9.5

%

 

 

141,368

 

 

8.8

%

Interest expense

 

12,383

 

0.8

%

 

 

13,528

 

 

0.8

%

Depreciation and amortization

 

41,037

 

2.6

%

 

 

37,854

 

 

2.4

%

Loss on extinguishment and modification of debt

 

 

0.0

%

 

 

1,898

 

 

0.0

%

Other non-operating gains

 

 

0.0

%

 

 

(23,202

)

 

(1.4

)%

Total operating expenses

 

1,512,708

 

94.2

%

 

 

1,439,043

 

 

89.6

%

Income before income taxes

 

92,371

 

5.8

%

 

 

167,246

 

 

10.4

%

Income tax expense

 

18,109

 

1.2

%

 

 

26,355

 

 

1.6

%

Net income

 

74,262

 

4.6

%

 

 

140,891

 

 

8.8

%

Net income attributable to noncontrolling interests

 

29,306

 

1.8

%

 

 

26,687

 

 

1.7

%

Net income attributable to Ardent Health, Inc.

$

44,956

 

2.8

%

 

$

114,204

 

 

7.1

%

 

 

 

 

 

 

 

 

Net income per share:

 

 

 

 

 

 

 

Basic

$

0.32

 

 

 

$

0.82

 

 

 

Diluted

$

0.32

 

 

 

$

0.81

 

 

 

Weighted-average common shares outstanding:

 

 

 

 

 

 

 

Basic

 

141,359,534

 

 

 

 

140,044,698

 

 

 

Diluted

 

142,099,858

 

 

 

 

140,828,828

 

 

 

Ardent Health, Inc.

Consolidated Income Statements

(Unaudited; dollars in thousands, except per share amounts)

 

 

Years Ended December 31,

 

2025

 

2024

 

Amount

 

%

 

Amount

 

%

Total revenue

$

6,324,339

 

 

100.0

%

 

$

5,966,072

 

 

100.0

%

Expenses:

 

 

 

 

 

 

 

Salaries and benefits

 

2,657,700

 

 

42.0

%

 

 

2,534,756

 

 

42.5

%

Professional fees

 

1,192,645

 

 

18.9

%

 

 

1,097,119

 

 

18.4

%

Supplies

 

1,082,908

 

 

17.1

%

 

 

1,033,122

 

 

17.3

%

Rents and leases

 

109,586

 

 

1.7

%

 

 

103,577

 

 

1.7

%

Rents and leases, related party

 

152,905

 

 

2.4

%

 

 

149,229

 

 

2.5

%

Other operating expenses

 

647,308

 

 

10.3

%

 

 

496,219

 

 

8.2

%

Interest expense

 

55,202

 

 

0.9

%

 

 

65,578

 

 

1.1

%

Depreciation and amortization

 

155,703

 

 

2.5

%

 

 

146,288

 

 

2.5

%

Loss on extinguishment and modification of debt

 

7,344

 

 

0.1

%

 

 

3,388

 

 

0.1

%

Other non-operating gains

 

(23,320

)

 

(0.4

)%

 

 

(26,264

)

 

(0.4

)%

Total operating expenses

 

6,037,981

 

 

95.5

%

 

 

5,603,012

 

 

93.9

%

Income before income taxes

 

286,358

 

 

4.5

%

 

 

363,060

 

 

6.1

%

Income tax expense

 

56,223

 

 

0.9

%

 

 

63,352

 

 

1.1

%

Net income

 

230,135

 

 

3.6

%

 

 

299,708

 

 

5.0

%

Net income attributable to noncontrolling interests

 

94,324

 

 

1.5

%

 

 

89,365

 

 

1.5

%

Net income attributable to Ardent Health, Inc.

$

135,811

 

 

2.1

%

 

$

210,343

 

 

3.5

%

 

 

 

 

 

 

 

 

Net income per share:

 

 

 

 

 

 

 

Basic

$

0.96

 

 

 

 

$

1.59

 

 

 

Diluted

$

0.96

 

 

 

 

$

1.58

 

 

 

Weighted-average common shares outstanding:

 

 

 

 

 

 

 

Basic

 

140,760,736

 

 

 

 

 

132,439,695

 

 

 

Diluted

 

141,450,309

 

 

 

 

 

132,744,577

 

 

 

Ardent Health, Inc.

Consolidated Statements of Cash Flows

(Unaudited; in thousands)

 

Years Ended December 31,

 

2025

 

2024

Cash flows from operating activities:

 

 

 

Net income

$

230,135

 

 

$

299,708

 

Adjustments to reconcile net income to net cash provided by operating activities:

 

 

 

Depreciation and amortization

 

155,703

 

 

 

146,288

 

Other non-operating losses (gains)

 

1,275

 

 

 

(4,702

)

Loss on extinguishment and modification of debt

 

515

 

 

 

2,158

 

Amortization of deferred financing costs and debt discounts

 

4,379

 

 

 

5,468

 

Deferred income taxes

 

43,594

 

 

 

24,044

 

Equity-based compensation

 

39,293

 

 

 

17,978

 

(Income) loss from non-consolidated affiliates

 

(1,043

)

 

 

5,835

 

Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:

 

 

 

Accounts receivable

 

59,155

 

 

 

40,001

 

Inventories

 

(3,148

)

 

 

(9,407

)

Prepaid expenses and other current assets

 

(122,094

)

 

 

(136,009

)

Accounts payable and other accrued expenses and liabilities

 

62,060

 

 

 

(103,860

)

Accrued salaries and benefits

 

686

 

 

 

27,524

 

Net cash provided by operating activities

 

470,510

 

 

 

315,026

 

Cash flows from investing activities:

 

 

 

Investment in acquisitions, net of cash acquired

 

(2,504

)

 

 

(35,542

)

Purchases of property and equipment

 

(211,904

)

 

 

(187,508

)

Proceeds from divestitures

 

 

 

 

4,297

 

Other

 

179

 

 

 

(1,707

)

Net cash used in investing activities

 

(214,229

)

 

 

(220,460

)

Cash flows from financing activities:

 

 

 

Proceeds from initial public offering, net of underwriting discounts and commissions

 

 

 

 

208,656

 

Proceeds from insurance financing arrangements

 

15,607

 

 

 

10,797

 

Proceeds from long-term debt

 

 

 

 

3,600

 

Payments of principal on insurance financing arrangements

 

(15,041

)

 

 

(10,443

)

Payments of principal on long-term debt

 

(7,988

)

 

 

(108,371

)

Debt issuance costs

 

(2,573

)

 

 

(2,450

)

Payments of initial public offering costs

 

 

 

 

(9,534

)

Distributions to noncontrolling interests

 

(88,239

)

 

 

(72,856

)

Other

 

(5,231

)

 

 

5,243

 

Net cash (used in) provided by financing activities

 

(103,465

)

 

 

24,642

 

Net increase in cash and cash equivalents

 

152,816

 

 

 

119,208

 

Cash and cash equivalents at beginning of period

 

556,785

 

 

 

437,577

 

Cash and cash equivalents at end of period

$

709,601

 

 

$

556,785

 

 

Supplemental Cash Flow Information:

 

 

 

Interest payments, net of capitalized interest

$

65,740

 

 

$

74,976

 

Non-cash purchases of property and equipment

$

16,369

 

 

$

9,276

 

Offering costs not yet paid

$

 

 

$

330

 

Income tax payments, net

$

36,510

 

 

$

41,603

 

Ardent Health, Inc.

Consolidated Balance Sheets

(Unaudited; dollars in thousands, except per share amounts)

 

 

December 31,

2025 (1)

 

December 31,

2024 (1)

Assets

 

 

 

Current assets:

 

 

 

Cash and cash equivalents

$

709,601

 

 

$

556,785

Accounts receivable

 

686,102

 

 

 

743,031

Inventories

 

118,593

 

 

 

115,093

Prepaid expenses

 

112,646

 

 

 

113,749

Other current assets

 

431,882

 

 

 

304,093

Total current assets

 

2,058,824

 

 

 

1,832,751

Property and equipment, net

 

935,769

 

 

 

861,899

Operating lease right of use assets

 

292,651

 

 

 

248,040

Operating lease right of use assets, related party

 

915,599

 

 

 

929,106

Goodwill

 

879,451

 

 

 

852,084

Other intangible assets

 

89,335

 

 

 

76,930

Deferred income taxes

 

6,888

 

 

 

12,321

Other assets

 

111,691

 

 

 

142,969

Total assets

$

5,290,208

 

 

$

4,956,100

 

 

 

 

Liabilities and Equity

 

 

 

Current liabilities:

 

 

 

Current installments of long-term debt

$

23,444

 

 

$

9,234

Accounts payable

 

457,936

 

 

 

401,249

Accrued salaries and benefits

 

296,260

 

 

 

295,117

Other accrued expenses and liabilities

 

268,904

 

 

 

239,824

Total current liabilities

 

1,046,544

 

 

 

945,424

Long-term debt, less current installments

 

1,075,782

 

 

 

1,085,818

Long-term operating lease liability

 

260,600

 

 

 

221,443

Long-term operating lease liability, related party

 

904,632

 

 

 

919,313

Self-insured liabilities

 

241,050

 

 

 

227,048

Other long-term liabilities

 

76,636

 

 

 

34,697

Total liabilities

 

3,605,244

 

 

 

3,433,743

 

 

 

 

Redeemable noncontrolling interests

 

(1,250

)

 

 

1,158

Equity:

 

 

 

Preferred stock, par value $0.01 per share; 50,000,000 shares authorized; no shares issued and outstanding

 

 

 

 

Common stock, par value $0.01 per share; 750,000,000 shares authorized; 142,864,171 and 142,747,818 shares issued and outstanding as of December 31, 2025 and 2024, respectively

 

1,429

 

 

 

1,428

Additional paid-in capital

 

788,472

 

 

 

754,415

Accumulated other comprehensive (loss) income

 

(3,610

)

 

 

9,737

Retained earnings

 

501,607

 

 

 

365,796

Equity attributable to Ardent Health, Inc.

 

1,287,898

 

 

 

1,131,376

Noncontrolling interests

 

398,316

 

 

 

389,823

Total equity

 

1,686,214

 

 

 

1,521,199

Total liabilities and equity

$

5,290,208

 

 

$

4,956,100

(1)

As of December 31, 2025 and 2024, the consolidated balance sheets included total liabilities of consolidated variable interest entities of $335.1 million and $306.4 million, respectively. Refer to Note 2 of the Company's consolidated financial statements included in its Annual Report on Form 10-K for further discussion.

Ardent Health, Inc.

Operating Statistics

(Unaudited)

 

 

Three Months Ended December 31,

 

Years Ended December 31,

 

2025

 

%

Change

 

2024

 

2025

 

%

Change

 

2024

Total revenue (in thousands)

$

1,605,079

 

 

(0.1

)%

 

$

1,606,289

 

 

$

6,324,339

 

 

6.0

%

 

$

5,966,072

 

Hospitals operated (at period end) (1)

 

30

 

 

0.0

%

 

 

30

 

 

 

30

 

 

0.0

%

 

 

30

 

Licensed beds (at period end) (2)

 

4,281

 

 

0.0

%

 

 

4,281

 

 

 

4,281

 

 

0.0

%

 

 

4,281

 

Utilization of licensed beds (3)

 

49

%

 

4.3

%

 

 

47

%

 

 

50

%

 

8.7

%

 

 

46

%

Admissions (4)

 

40,896

 

 

1.5

%

 

 

40,300

 

 

 

165,682

 

 

5.3

%

 

 

157,295

 

Adjusted admissions (5)

 

88,583

 

 

2.0

%

 

 

86,872

 

 

 

349,614

 

 

2.3

%

 

 

341,781

 

Inpatient surgeries (6)

 

9,466

 

 

3.9

%

 

 

9,108

 

 

 

38,288

 

 

6.5

%

 

 

35,937

 

Outpatient surgeries (7)

 

23,976

 

 

(1.3

)%

 

 

24,296

 

 

 

91,361

 

 

(2.3

)%

 

 

93,497

 

Total surgeries

 

33,442

 

 

0.1

%

 

 

33,404

 

 

 

129,649

 

 

0.2

%

 

 

129,434

 

Emergency room visits (8)

 

158,256

 

 

(1.7

)%

 

 

161,010

 

 

 

637,325

 

 

0.2

%

 

 

636,222

 

Patient days (9)

 

192,851

 

 

4.7

%

 

 

184,167

 

 

 

777,361

 

 

7.3

%

 

 

724,363

 

Total encounters (10)

 

1,582,219

 

 

6.8

%

 

 

1,481,612

 

 

 

6,102,034

 

 

5.5

%

 

 

5,785,709

 

Average length of stay (11)

 

4.72

 

 

3.3

%

 

 

4.57

 

 

 

4.69

 

 

1.7

%

 

 

4.61

 

Net patient service revenue per adjusted admission (12)

$

17,757

 

 

(2.4

)%

 

$

18,200

 

 

$

17,748

 

 

3.5

%

 

$

17,144

 

(1)

Hospitals operated (at period end). This metric represents the total number of hospitals operated by us at the end of the applicable period, irrespective of whether the hospital real estate is (i) owned by us, (ii) leased by us or (iii) held through a controlling interest in a JV. This metric includes the managed clinical operations of the hospital at UT Health North Campus in Tyler, Texas ("UT Health North Campus Tyler"), a hospital owned by The University of Texas Health Science Center at Tyler ("UTHSCT"), an affiliate of The University of Texas System. Since we only manage the clinical operations of UT Health North Campus Tyler, the financial results of such entity are not consolidated under Ardent Health, Inc.

(2)

Licensed beds (at period end). This metric represents the total number of beds for which the appropriate state agency licenses a facility, regardless of whether the beds are actually available for patient use.

(3)

Utilization of licensed beds. This metric represents a measure of the actual utilization of our inpatient facilities, computed by (i) dividing patient days by the number of days in each period, and (ii) further dividing that number by average licensed beds, which is calculated by dividing total licensed beds (at period end) by the number of days in the period, multiplied by the number of days in the period the licensed beds were in existence.

(4)

Admissions. This metric represents the number of patients admitted for inpatient treatment during the applicable period.

(5)

Adjusted admissions. This metric is used by management as a general measure of combined inpatient and outpatient volume. Adjusted admissions provides management with a key performance indicator that considers both inpatient and outpatient volumes by applying an inpatient volume measure (admissions) to a ratio of gross inpatient and outpatient revenue to gross inpatient revenue. Gross inpatient and outpatient revenue reflect gross inpatient and outpatient charges prior to estimated contractual adjustments, uninsured discounts, implicit price concessions, and other discounts. The calculation of adjusted admissions is summarized as follows:

Adjusted Admissions

=

Admissions

x

(Gross Inpatient Revenue + Gross Outpatient Revenue)

 

 

 

 

 

Gross Inpatient Revenue

 

(6)

Inpatient surgeries. This metric represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management, c-sections, and certain diagnostic procedures are excluded from inpatient surgeries.

(7)

Outpatient surgeries. This metric represents the number of surgeries performed on patients who have not been admitted to our hospitals. Pain management, c-sections, and certain diagnostic procedures are excluded from outpatient surgeries.

(8)

Emergency room visits. This metric represents the total number of patients provided with emergency room treatment during the applicable period.

(9)

Patient days. This metric represents the total number of days of care provided to patients admitted to our hospitals during the applicable period.

(10)

Total encounters. This metric represents the total number of events where healthcare services are rendered resulting in a billable event during the applicable period. This includes both hospital and ambulatory patient interactions.

(11)

Average length of stay. This metric represents the average number of days admitted patients stay in our hospitals.

(12)

Net patient service revenue per adjusted admission. This metric represents net patient service revenue divided by adjusted admissions for the applicable period. Net patient service revenue reflects gross inpatient and outpatient charges less estimated contractual adjustments, uninsured discounts, implicit price concessions, and other discounts.

Ardent Health, Inc.

Supplemental Non-GAAP Disclosures

(Unaudited; in thousands)

 

 

Three Months Ended December 31,

 

Years Ended December 31,

 

2025

 

2024

 

2025

 

2024

Net income

$

74,262

 

 

$

140,891

 

 

$

230,135

 

 

$

299,708

 

Adjusted EBITDA Addbacks:

 

 

 

 

 

 

 

Income tax expense

 

18,109

 

 

 

26,355

 

 

 

56,223

 

 

 

63,352

 

Interest expense

 

12,383

 

 

 

13,528

 

 

 

55,202

 

 

 

65,578

 

Depreciation and amortization

 

41,037

 

 

 

37,854

 

 

 

155,703

 

 

 

146,288

 

Noncontrolling interest earnings

 

(29,306

)

 

 

(26,687

)

 

 

(94,324

)

 

 

(89,365

)

Loss on extinguishment and modification of debt

 

 

 

 

 

 

 

7,344

 

 

 

3,388

 

Other non-operating (gains) losses (1)

 

 

 

 

(4,702

)

 

 

1,130

 

 

 

(4,910

)

Cybersecurity Incident recoveries, net (2)

 

 

 

 

(16,501

)

 

 

(22,655

)

 

 

(21,477

)

Certain legal matters and related costs

 

900

 

 

 

2,000

 

 

 

900

 

 

 

2,000

 

Restructuring, exit and acquisition-related costs (3)

 

5,332

 

 

 

1,057

 

 

 

13,276

 

 

 

12,751

 

Change in accounting estimate (4)

 

 

 

 

 

 

 

43,298

 

 

 

 

New Mexico professional liability accrual (5)

 

 

 

 

 

 

 

54,468

 

 

 

 

Epic expenses (6)

 

1,933

 

 

 

1,673

 

 

 

4,837

 

 

 

3,173

 

Equity-based compensation

 

9,110

 

 

 

9,105

 

 

 

39,293

 

 

 

17,978

 

Loss (income) from disposed operations

 

185

 

 

 

(1,980

)

 

 

207

 

 

 

9

 

Adjusted EBITDA

$

133,945

 

 

$

182,593

 

 

$

545,037

 

 

$

498,473

 

Total revenue

$

1,605,079

 

 

$

1,606,289

 

 

$

6,324,339

 

 

$

5,966,072

 

Adjusted EBITDA margin

 

8.3

%

 

 

11.4

%

 

 

8.6

%

 

 

8.4

%

(1)

Other non-operating (gains) losses include gains and losses realized on certain non-recurring events or events that are non-operational in nature.

(2)

Cybersecurity Incident recoveries, net represent insurance recovery proceeds associated with the Cybersecurity Incident, net of incremental information technology and litigation costs.

(3)

Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work force reductions of $4.3 million and $0.3 million for the three months ended December 31, 2025 and 2024, respectively, and $10.3 million and $10.4 million for the years ended December 31, 2025 and 2024, respectively, (ii) penalties and costs incurred for terminating pre-existing contracts at acquired facilities of $0.8 million and $0.2 million for the three months ended December 31, 2025 and 2024, respectively, and $1.2 million and $0.8 million for the years ended December 31, 2025 and 2024, respectively, and (iii) third-party professional fees and expenses, salaries and benefits, and other internal expenses incurred in connection with potential and completed acquisitions of $0.2 million and $0.6 million for the three months ended December 31, 2025 and 2024, respectively, and $1.8 million and $1.6 million for the years ended December 31, 2025 and 2024, respectively.

(4)

Change in accounting estimate reflects the reduction in total revenue of $42.6 million and its $0.7 million impact on noncontrolling interest earnings as a result of a change in our accounting estimate of the collectability of accounts receivable. See Note 2 to our consolidated financial statements included in our Annual Report on Form 10-K for further detail.

(5)

During the year ended December 31, 2025, we recorded adjustments to our professional liability expense of $63.3 million. These adjustments included $54.5 million of additional expense recorded during the third quarter of 2025 for adverse prior-period claim developments in New Mexico that was primarily attributable to recent claim settlements and ongoing litigation arising from the actions of a single provider who was employed between 2019 and 2022. See Note 11 to our consolidated financial statements included in our Annual Report on Form 10-K for further detail.

(6)

Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology system. These costs included (i) professional fees of $0.6 million and $1.6 million for the three months ended December 31, 2025 and 2024, respectively, and $2.1 million and $3.1 million for the years ended December 31, 2025 and 2024, respectively, (ii) salaries and benefits of $1.3 million and $0.1 million for the three months ended December 31, 2025 and 2024, respectively, and $2.6 million and $0.1 million for the years ended December 31, 2025 and 2024, respectively, and (iii) other expenses related to one-time training and onboarding support costs of $0.1 million for the year ended December 31, 2025. Epic expenses do not include ongoing operating costs of the Epic system.

Ardent Health, Inc.

Supplemental Non-GAAP Disclosures

(Unaudited; in thousands)

 

 

Three Months Ended

December 31, 2025

 

Year Ended

December 31, 2025

Net income

$

74,262

 

 

$

230,135

 

Adjusted EBITDAR Addbacks:

 

 

 

Income tax expense

 

18,109

 

 

 

56,223

 

Interest expense

 

12,383

 

 

 

55,202

 

Depreciation and amortization

 

41,037

 

 

 

155,703

 

Noncontrolling interest earnings

 

(29,306

)

 

 

(94,324

)

Loss on extinguishment and modification of debt

 

 

 

 

7,344

 

Other non-operating losses (1)

 

 

 

 

1,130

 

Cybersecurity Incident recoveries, net (2)

 

 

 

 

(22,655

)

Certain legal matters and related costs

 

900

 

 

 

900

 

Restructuring, exit and acquisition-related costs (3)

 

5,332

 

 

 

13,276

 

Change in accounting estimate (4)

 

 

 

 

43,298

 

New Mexico professional liability accrual (5)

 

 

 

 

54,468

 

Epic expenses (6)

 

1,933

 

 

 

4,837

 

Equity-based compensation

 

9,110

 

 

 

39,293

 

Loss from disposed operations

 

185

 

 

 

207

 

Rent expense payable to REITs (7)

 

41,786

 

 

 

164,308

 

Adjusted EBITDAR

$

175,731

 

 

$

709,345

 

(1)

Other non-operating losses include losses realized on certain non-recurring events or events that are non-operational in nature.

(2)

Cybersecurity Incident recoveries, net represent insurance recovery proceeds associated with the Cybersecurity Incident, net of incremental information technology and litigation costs.

(3)

Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work force reductions of $4.3 million and $10.3 million for the three months ended and year ended December 31, 2025, respectively, (ii) penalties and costs incurred for terminating pre-existing contracts at acquired facilities of $0.8 million and $1.2 million for the three months ended and year ended December 31, 2025, respectively, and (iii) third-party professional fees and expenses, salaries and benefits, and other internal expenses incurred in connection with potential and completed acquisitions of $0.2 million and $1.8 million for the three months ended and year ended December 31, 2025, respectively.

(4)

Change in accounting estimate reflects the reduction in total revenue of $42.6 million and its $0.7 million impact on noncontrolling interest earnings as a result of a change in our accounting estimate of the collectability of accounts receivable. See Note 2 to our consolidated financial statements included in our Annual Report on Form 10-K for further detail.

(5)

During the year ended December 31, 2025, we recorded adjustments to our professional liability expense of $63.3 million. These adjustments included $54.5 million of additional expense recorded during the third quarter of 2025 for adverse prior-period claim developments in New Mexico that was primarily attributable to recent claim settlements and ongoing litigation arising from the actions of a single provider who was employed between 2019 and 2022. See Note 11 to our consolidated financial statements included in our Annual Report on Form 10-K for further detail.

(6)

Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology system. These costs included (i) professional fees of $0.6 million and $2.1 million for the three months ended and year ended December 31, 2025, respectively, (ii) salaries and benefits of $1.3 million and $2.6 million for the three months ended and year ended December 31, 2025, respectively, and (iii) other expenses related to one-time training and onboarding support costs of $0.1 million for the year ended December 31, 2025. Epic expenses do not include ongoing operating costs of the Epic system.

(7)

Rent expense payable to REITs for the three months ended and year ended December 31, 2025 consists of rent expense of $38.9 million and $152.9 million, respectively, related to the Ventas Master Lease and other lease agreements with Ventas for medical office buildings and rent expense of $2.9 million and $11.4 million, respectively, related to a lease arrangement with MPT for the lease of Hackensack Meridian Mountainside Medical Center.

Ardent Health, Inc.

Supplemental Non-GAAP Disclosures

(Unaudited; in millions)

 

 

Guidance for the Full Year Ending

December 31, 2026

 

Low

 

High

Net income

$

221

 

 

$

280

 

Adjusted EBITDA Addbacks:

 

 

 

Income tax expense

 

58

 

 

 

73

 

Interest expense

 

56

 

 

 

53

 

Depreciation and amortization

 

175

 

 

 

170

 

Noncontrolling interest earnings

 

(92

)

 

 

(97

)

Cybersecurity Incident recoveries (1)

 

(7

)

 

 

(7

)

Other expenses, including restructuring and enterprise system conversion costs

 

28

 

 

 

21

 

Equity-based compensation

 

46

 

 

 

42

 

Adjusted EBITDA

$

485

 

 

$

535

 

(1)

Cybersecurity Incident recoveries represent insurance recovery proceeds associated with the Cybersecurity Incident.

 

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