Tenet Healthcare (THC) 10-K 16 Feb 24 2023 FY Annual report Financial data

Cover Page

Cover Page - USD ($) shares in Thousands, $ in Billions	12 Months Ended
	Dec. 31, 2023	Jan. 31, 2024	Jun. 30, 2023
Entity Information [Line Items]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	1-7293
Entity Registrant Name	TENET HEALTHCARE CORP
Entity Incorporation, State or Country Code	NV
Entity Tax Identification Number	95-2557091
Entity Address, Address Line One	14201 Dallas Parkway
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75254
City Area Code	469
Local Phone Number	893-2200
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction	false
Entity Shell Company	false
Entity Public Float			$ 6.4
Entity Common Stock, Shares Outstanding		99,995
Documents Incorporated by Reference	Portions of the Registrant’s definitive proxy statement for the 2024 annual meeting of shareholders are incorporated by reference into Part III of this Form 10-K.
Entity Central Index Key	0000070318
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Common Stock | New York Stock Exchange
Entity Information [Line Items]
Title of 12(b) Security	Common stock, $0.05 par value
Trading Symbol	THC
Security Exchange Name	NYSE
6.875% Senior Notes due 2031 | New York Stock Exchange
Entity Information [Line Items]
Title of 12(b) Security	6.875% Senior Notes due 2031
Trading Symbol	THC31
Security Exchange Name	NYSE

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2023
Audit Information [Abstract]
Auditor Name	DELOITTE & TOUCHE LLP
Auditor Location	Dallas, Texas
Auditor Firm ID	34

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 1,228	$ 858
Accounts receivable	2,914	2,943
Inventories of supplies, at cost	411	405
Assets held for sale	775	0
Other current assets	1,839	1,775
Total current assets	7,167	5,981
Investments and other assets	3,157	3,147
Deferred income taxes	77	19
Property and equipment, at cost, less accumulated depreciation and amortization ($6,478 at December 31, 2023 and $6,201 at December 31, 2022)	6,236	6,462
Goodwill	10,307	10,123
Other intangible assets, at cost, less accumulated amortization ($1,447 at December 31, 2023 and $1,428 at December 31, 2022)	1,368	1,424
Total assets	28,312	27,156
Current liabilities:
Current portion of long-term debt	120	145
Accounts payable	1,408	1,504
Accrued compensation and benefits	930	778
Professional and general liability reserves	254	255
Accrued interest payable	200	213
Liabilities held for sale	69	0
Other current liabilities	1,779	1,581
Total current liabilities	4,760	4,476
Long-term debt, net of current portion	14,882	14,934
Professional and general liability reserves	792	790
Defined benefit plan obligations	335	331
Deferred income taxes	326	217
Other long-term liabilities	1,709	1,800
Total liabilities	22,804	22,548
Commitments and contingencies
Redeemable noncontrolling interests in equity of consolidated subsidiaries	2,391	2,149
Shareholders’ equity:
Common stock, $0.05 par value; authorized 262,500 shares; 157,271 shares issued at December 31, 2023 and 156,462 shares issued at December 31, 2022	8	8
Additional paid-in capital	4,834	4,778
Accumulated other comprehensive loss	(181)	(181)
Accumulated deficit	(192)	(803)
Common stock in treasury, at cost, 57,321 shares at December 31, 2023 and 54,215 shares at December 31, 2022	(2,861)	(2,660)
Total shareholders’ equity	1,608	1,142
Noncontrolling interests	1,509	1,317
Total equity	3,117	2,459
Total liabilities and equity	$ 28,312	$ 27,156

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) shares in Thousands, $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation and amortization	$ 6,478	$ 6,201
Other intangible assets, accumulated amortization	$ 1,447	$ 1,428
Common stock, par value (in dollars per share)	$ 0.05	$ 0.05
Common stock, number of shares authorized (in shares)	262,500	262,500
Common stock, number of shares issued (in shares)	157,271	156,462
Common stock, number of shares held in treasury (in shares)	57,321	54,215

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Net operating revenues	$ 20,548	$ 19,174	$ 19,485
Grant income	16	194	191
Equity in earnings of unconsolidated affiliates	228	216	218
Operating expenses:
Salaries, wages and benefits	9,146	8,844	8,878
Supplies	3,590	3,273	3,328
Other operating expenses, net	4,515	3,998	4,206
Depreciation and amortization	870	841	855
Impairment and restructuring charges, and acquisition-related costs	137	226	85
Litigation and investigation costs	47	70	116
Net gains on sales, consolidation and deconsolidation of facilities	(23)	(1)	(445)
Operating income	2,510	2,333	2,871
Interest expense	(901)	(890)	(923)
Other non-operating income, net	19	10	14
Loss from early extinguishment of debt	(11)	(109)	(74)
Income from continuing operations, before income taxes	1,617	1,344	1,888
Income tax expense	(306)	(344)	(411)
Income from continuing operations, before discontinued operations	1,311	1,000	1,477
Discontinued operations:
Income (loss) from operations	0	1	(1)
Income (loss) from discontinued operations, net of tax	0	1	(1)
Net income	1,311	1,001	1,476
Less: Net income available to noncontrolling interests	700	590	562
Net income available to Tenet Healthcare Corporation common shareholders	611	411	914
Amounts available to Tenet Healthcare Corporation common shareholders:
Income from continuing operations, net of tax	611	410	915
Income (loss) from discontinued operations, net of tax	0	1	(1)
Net income available to Tenet Healthcare Corporation common shareholders	$ 611	$ 411	$ 914
Basic
Continuing operations (in dollars per share)	$ 6.01	$ 3.83	$ 8.56
Discontinued operations (in dollars per share)	0	0.01	(0.01)
Total earnings (loss) per share, Basic (in dollars per share)	6.01	3.84	8.55
Diluted
Continuing operations (in dollars per share)	5.71	3.78	8.43
Discontinued operations (in dollars per share)	0	0.01	(0.01)
Total earnings (loss) per share, Diluted (in dollars per share)	$ 5.71	$ 3.79	$ 8.42
Weighted average shares and dilutive securities outstanding (in thousands):
Basic (in shares)	101,639	106,929	106,833
Diluted (in shares)	104,800	110,516	108,571

CONSOLIDATED STATEMENTS OF OTHE

CONSOLIDATED STATEMENTS OF OTHER COMPREHENSIVE INCOME - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Net income	$ 1,311	$ 1,001	$ 1,476
Other comprehensive income:
Adjustments for defined benefit plans	(9)	63	50
Amortization of net actuarial loss included in other non-operating income, net	7	9	11
Unrealized gain (loss) on debt securities held as available-for-sale	2	(4)	0
Foreign currency translation adjustments and other	0	1	1
Other comprehensive income before income taxes	0	69	62
Income tax expense related to items of other comprehensive income	0	(17)	(14)
Total other comprehensive income, net of tax	0	52	48
Comprehensive net income	1,311	1,053	1,524
Less: Comprehensive income available to noncontrolling interests	700	590	562
Comprehensive income available to Tenet Healthcare Corporation common shareholders	$ 611	$ 463	$ 962

CONSOLIDATED STATEMENTS OF CHAN

CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY - USD ($) shares in Thousands, $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Treasury Stock	Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2020		106,070
Beginning balance at Dec. 31, 2020	$ 937	$ 7	$ 4,844	$ (281)	$ (2,128)	$ (2,414)	$ 909
Changes in Shareholders' Equity
Net income	1,140				914		226
Distributions paid to noncontrolling interests	(206)						(206)
Other comprehensive income	48			48
Accretion of redeemable noncontrolling interests	(11)		(11)
Purchases of businesses and noncontrolling interests, net	97		0				97
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)		1,119
Stock-based compensation expense, tax benefit and issuance of common stock	49	$ 1	44			4
Ending balance (in shares) at Dec. 31, 2021		107,189
Ending balance at Dec. 31, 2021	2,054	$ 8	4,877	(233)	(1,214)	(2,410)	1,026
Changes in Shareholders' Equity
Net income	653				411		242
Distributions paid to noncontrolling interests	(229)						(229)
Other comprehensive income	52			52
Accretion of redeemable noncontrolling interests	(104)		(104)
Purchases of businesses and noncontrolling interests, net	244		(34)				278
Repurchases of common stock (in shares)		(5,889)
Repurchases of common stock	(250)					(250)
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)		947
Stock-based compensation expense, tax benefit and issuance of common stock	39	$ 0	39			0
Ending balance (in shares) at Dec. 31, 2022		102,247
Ending balance at Dec. 31, 2022	2,459	$ 8	4,778	(181)	(803)	(2,660)	1,317
Changes in Shareholders' Equity
Net income	945				611		334
Distributions paid to noncontrolling interests	(289)						(289)
Other comprehensive income	0
Purchases of businesses and noncontrolling interests, net	152		5				147
Repurchases of common stock (in shares)		(3,112)
Repurchases of common stock	(201)					(201)
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)		815
Stock-based compensation expense, tax benefit and issuance of common stock	51		51
Ending balance (in shares) at Dec. 31, 2023		99,950
Ending balance at Dec. 31, 2023	$ 3,117	$ 8	$ 4,834	$ (181)	$ (192)	$ (2,861)	$ 1,509

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Cash Flows [Abstract]
Net income	$ 1,311	$ 1,001	$ 1,476
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	870	841	855
Deferred income tax expense	52	209	250
Stock-based compensation expense	66	56	56
Impairment and restructuring charges, and acquisition-related costs	137	226	85
Litigation and investigation costs	47	70	116
Net gains on sales, consolidation and deconsolidation of facilities	(23)	(1)	(445)
Loss from early extinguishment of debt	11	109	74
Equity in earnings of unconsolidated affiliates, net of distributions received	(13)	2	(10)
Amortization of debt discount and debt issuance costs	32	33	33
Pre-tax loss (income) from discontinued operations	0	(1)	1
Net gains from the sale of investments and long-lived assets	(29)	(117)	(23)
Other items, net	(4)	13	(10)
Changes in cash from operating assets and liabilities:
Accounts receivable	(29)	(140)	(197)
Inventories and other current assets	(139)	(64)	(52)
Income taxes	10	(26)	68
Accounts payable, accrued expenses, contract liabilities and other current liabilities	215	(898)	(584)
Other long-term liabilities	14	(15)	28
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements	(154)	(214)	(153)
Net cash used in operating activities from discontinued operations, excluding income taxes	0	(1)	0
Net cash provided by operating activities	2,374	1,083	1,568
Cash flows from investing activities:
Purchases of property and equipment	(751)	(762)	(658)
Purchases of businesses or joint venture interests, net of cash acquired	(224)	(234)	(1,220)
Proceeds from sales of facilities and other assets	71	210	1,248
Proceeds from sales of marketable securities and long-term investments	50	76	31
Purchases of marketable securities and equity investments	(104)	(92)	(108)
Other items, net	(11)	(6)	(7)
Net cash used in investing activities	(969)	(808)	(714)
Cash flows from financing activities:
Repayments of borrowings	(1,542)	(2,851)	(3,221)
Proceeds from borrowings	1,370	2,023	2,872
Repurchases of common stock	(200)	(250)	0
Debt issuance costs	(16)	(24)	(31)
Distributions paid to noncontrolling interests	(594)	(560)	(423)
Proceeds from the sale of noncontrolling interests	43	27	25
Purchases of noncontrolling interests	(167)	(100)	(27)
Medicare advances and grants received by unconsolidated affiliates, net of recoupment	0	0	(67)
Other items, net	71	(46)	(64)
Net cash used in financing activities	(1,035)	(1,781)	(936)
Net increase (decrease) in cash and cash equivalents	370	(1,506)	(82)
Cash and cash equivalents at beginning of period	858	2,364	2,446
Cash and cash equivalents at end of period	1,228	858	2,364
Supplemental disclosures:
Interest paid, net of capitalized interest	(882)	(848)	(937)
Income tax payments, net	$ (243)	$ (161)	$ (92)

SIGNIFICANT ACCOUNTING POLICIES

SIGNIFICANT ACCOUNTING POLICIES	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
SIGNIFICANT ACCOUNTING POLICIES	SIGNIFICANT ACCOUNTING POLICIES Description of Business Tenet Healthcare Corporation (together with our subsidiaries, referred to herein as “Tenet,” “we” or “us”) is a diversified healthcare services company headquartered in Dallas, Texas. At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (“Hospital Operations”). The results of the revenue cycle management and value-based care services we provide to hospitals, health systems, physician practices, employers and other clients previously reported under our Conifer segment are now combined with our Hospital Operations segment. See below for additional discussion of this change. Our expansive, nationwide care delivery network now consists of our Hospital Operations and Ambulatory Care segments. As of December 31, 2023, our Hospital Operations segment was comprised of our 61 acute care and specialty hospitals, a network of employed physicians and 164 outpatient facilities, including imaging centers, urgent care centers (each, a “UCC”), ancillary emergency facilities and micro‑hospitals. Our Ambulatory Care segment is comprised of the operations of our subsidiary USPI Holding Company, Inc. (“USPI”), which held indirect ownership interests in 461 ambulatory surgery centers and 24 surgical hospitals at December 31, 2023. USPI held noncontrolling interests in 155 of these facilities, which are recorded using the equity method of accounting. Effective June 30, 2022, we purchased all of the shares in USPI that Baylor University Medical Center (“Baylor”) held on that date for $406 million, which increased our ownership interest in USPI’s voting shares from 95% to 100% (see Note 13 for additional information about this transaction). In addition, we operate a Global Business Center (“GBC”) in Manila, Philippines. Basis of Presentation Our Consolidated Financial Statements include the accounts of Tenet and its wholly owned and majority‑owned subsidiaries. We eliminate intercompany accounts and transactions in consolidation, and we include the results of operations of businesses that are newly acquired in purchase transactions from their dates of acquisition. We account for significant investments in other affiliated companies using the equity method. We also utilize the equity method when we have the ability to exercise significant influence over the affiliated company, despite not holding a significant percentage of its ownership interest. Unless otherwise indicated, all financial and statistical data included in these notes to our Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts) and share amounts expressed in thousands. We adopted the Financial Accounting Standards Board’s (“FASB”) Accounting Standards Update (“ASU”) 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (“ASU 2020-06”), effective as of January 1, 2022 using the modified retrospective method. Among other amendments, ASU 2020-06 changed the accounting for diluted earnings‑per‑share for convertible instruments and contracts that may be settled in cash or stock. ASU 2020-06 eliminated an entity’s ability to rebut the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. Additionally, ASU 2020-06 requires that the if‑converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments. As a result of our adoption of ASU 2020-06, diluted weighted average shares outstanding increased by approximately 2,364 thousand shares and 2,673 thousand shares for the years ended December 31, 2023 and 2022, respectively, and diluted earnings per share available to Tenet common shareholders decreased by $0.26 and $0.01, respectively, for these same periods. Changes to prior-year presentation— At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). This change was made to reflect recent updates to the organizational and management structure of our Conifer and Hospital Operations and other segments. All prior‑period data presented in this report has been adjusted to conform to our new reporting segment structure. As of December 31, 2023, our business was organized into two reporting segments: • our Hospital Operations segment, which includes (1) our acute care and specialty hospitals, physician practices, imaging centers, UCCs, ancillary emergency facilities and micro‑hospitals, and (2) the revenue cycle management and value‑based care services we provide to hospitals, health systems, physician practices, employers and other clients through our Conifer Health Solutions, LLC joint venture; and • our Ambulatory Care segment, which is comprised of the ambulatory surgery center and surgical hospital operations of our subsidiary USPI Holding Company, Inc. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires us to make estimates and assumptions that affect the amounts reported in our Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Although we believe all adjustments considered necessary for a fair presentation have been included, actual results may vary from those estimates. The financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from the amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public. COVID-19 Pandemic During the COVID‑19 pandemic, federal, state and local authorities undertook several actions designed to assist healthcare providers in delivering care to COVID‑19 and other patients and to mitigate the adverse economic impact of the pandemic. Among other things, federal legislation (collectively, the “COVID Acts”) authorized grant payments to be distributed through the Public Health and Social Services Emergency Fund (“PRF”) to healthcare providers who experienced lost revenues and increased expenses as a result of the pandemic. The COVID Acts also revised the Medicare accelerated payment program (“MAPP”) and permitted employers to defer payroll Social Security tax payments in 2020. Our participation in these programs and the related accounting policies are summarized below. The Secretary of the U.S. Department of Health and Human Services (“HHS”) ended the COVID‑19 Public Health Emergency in May 2023. Grant Income— As detailed in the table below, we received cash payments from the PRF and state and local grant programs during the years ended December 31, 2023, 2022 and 2021. Grant funds received by our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate are included in cash flows from operating activities in our consolidated statements of cash flows. Grant funds received by unconsolidated affiliates for which we provide cash management services (“Cash‑Managed Affiliates”) are included in cash flows from financing activities. Years Ended December 31, 2023 2022 2021 Grant funds received from COVID-19 relief programs: Included in cash flows from operating activities: Hospital Operations $ 10 $ 193 $ 142 Ambulatory Care — 3 36 $ 10 $ 196 $ 178 Included in cash flows from financing activities: Cash‑Managed Affiliates $ — $ — $ 37 To receive distributions, providers agreed to certain terms and conditions, including, among other things, that the funds would be used for lost revenues and unreimbursed pandemic‑related costs as defined by HHS, and that the providers would not seek collection of out‑of‑pocket payments from a COVID‑19 patient that are greater than what the patient would have otherwise been required to pay if the care had been delivered by an in‑network provider. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by the Secretary of HHS. PRF funds not utilized by the established deadlines, generally 12 to 18 months after receipt, will be recouped by HHS. We recognize grant payments as income when there is reasonable assurance that we have complied with the conditions associated with the grant. The table below summarizes grant income recognized by our Hospital Operations and Ambulatory Care segments, which is presented in grant income, and grant income recognized through our unconsolidated affiliates, which is presented in equity in earnings of unconsolidated affiliates, in each case in our consolidated statements of operations. Years Ended December 31, 2023 2022 2021 Grant income recognized from COVID-19 relief programs: Included in grant income: Hospital Operations $ 15 $ 190 $ 142 Ambulatory Care 1 4 49 $ 16 $ 194 $ 191 Included in equity in earnings of unconsolidated affiliates: Unconsolidated affiliates $ — $ — $ 14 We had no deferred grant payments remaining at December 31, 2023, and we had $7 million of deferred grant payments at December 31, 2022, which amount was recorded in other current liabilities in the accompanying Consolidated Balance Sheet. Medicare Accelerated Payment Program (MAPP)— In certain circumstances, when a healthcare facility is experiencing financial difficulty due to delays in receiving payment for the Medicare services it provided, it may be eligible for an accelerated or advance payment pursuant to the MAPP. The COVID Acts revised the MAPP to disburse payments to healthcare providers more quickly and to allow recipients to retain the advance payments for one year from the date of receipt before recoupment commenced through offsets of Medicare claims payments. Recipients were also permitted to repay the advance payments at any time. Our Hospital Operations and Ambulatory Care segments both received advance payments from the MAPP following its expansion under the COVID Acts in the year ended December 31, 2020; however, no additional advances were received in the subsequent years. The table below summarizes MAPP advances received in prior periods that were repaid or recouped during the years ended December 31, 2022 and 2021. No advances were repaid or recouped during the year ended December 31, 2023. Advances to our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate were recouped through a reduction of their respective Medicare claims payments and, together with any repayments, are presented in cash flows from operating activities in our consolidated statements of cash flows. Advance payments to our Cash‑Managed Affiliates were recouped through a reduction of those affiliates’ Medicare claims payments and, together with any repayments, are presented in cash flows from financing activities. Years Ended December 31, 2022 2021 MAPP advances repaid or recouped: Included in cash flows from operating activities: Hospital Operations $ 876 $ 457 Ambulatory Care 4 55 $ 880 $ 512 Included in cash flows from financing activities: Cash‑Managed Affiliates $ — $ 104 All remaining MAPP advances we previously received were fully repaid or recouped during the year ended December 31, 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. Deferral of Employment Tax Payments— The COVID Acts permitted employers to defer payment of the 6.2% employer Social Security tax beginning March 27, 2020 through December 31, 2020. Deferred tax amounts were required to be paid in equal amounts over two years beginning in December 2021. We remitted the employer’s Social Security tax payments deferred during 2020 in payments of $128 million in December 2022 and 2021. Translation of Foreign Currencies Our GBC, which is located in the Philippines, performs certain administrative functions and other support tasks. The GBC’s accounts are measured in its local currency (the Philippine peso) and then translated into U.S. dollars. All assets and liabilities denominated in foreign currency are translated using the current rate of exchange at the balance sheet date. Results of operations denominated in foreign currency are translated using the average rates prevailing throughout the period of operations. Translation gains or losses resulting from changes in exchange rates are accumulated in shareholders’ equity. Net Operating Revenues We recognize net operating revenues in the period in which we satisfy our performance obligations under contracts by transferring services to our customers. Net operating revenues are recognized in the amounts we expect to be entitled to, which are the transaction prices allocated for the distinct services. Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients (“ Compact ”) and other uninsured discount and charity programs. Net Patient Service Revenues We report net patient service revenues at the amounts that reflect the consideration we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third‑party payers (including managed care payers and government programs) and others, and they include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews and investigations. Generally, we bill our patients and third‑party payers several days after the services are performed or shortly after discharge. Revenues are recognized as performance obligations are satisfied. We determine performance obligations based on the nature of the services we provide. We recognize revenues for performance obligations satisfied over time based on actual charges incurred in relation to total expected charges. We believe that this method provides a faithful depiction of the transfer of services over the term of performance obligations based on the inputs needed to satisfy the obligations. Generally, performance obligations satisfied over time relate to patients in our hospitals receiving inpatient acute care services. We measure performance obligations from admission to the point when there are no further services required for the patient, which is generally the time of discharge. We recognize revenues for performance obligations satisfied at a point in time, which generally relate to patients receiving outpatient services, when (1) services are provided, and (2) we do not believe the patient requires additional services. Because our patient service performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in FASB Accounting Standards Codification (“ASC”) 606‑10‑50‑14(a) and, therefore, we are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by contractual adjustments recognized for third‑party payers, discounts provided to uninsured patients in accordance with our Compact , and estimated implicit price concessions related primarily to uninsured patients. We determine our estimates of contractual adjustments and discounts based on contractual agreements, our discount policies and historical experience. We determine our estimate of implicit price concessions based on our historical collection experience using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach. Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and, therefore, are not displayed in our consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop‑loss payments). Because Medicare requires that a hospital’s gross charges be the same for all patients (regardless of payer category), gross charges are what hospitals charge all patients prior to the application of discounts and allowances. Government Programs— The final determination of certain fee‑for‑service (“FFS”) Medicare and Medicaid program payments to our hospitals, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, are retrospectively determined based on our hospitals’ cost reports. The final determination of these payments often takes many years to resolve because of audits by the program representatives, providers’ rights of appeal, and the application of numerous technical reimbursement provisions. We therefore record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we adjust the accrual for estimated cost report settlements based on those cost reports and subsequent activity, and we consider the necessity of recording a valuation allowance based on historical settlement results. The accrual for estimated cost report settlements for periods for which a cost report is yet to be filed is recorded based on estimates of what we expect to report on the filed cost reports, and a corresponding valuation allowance is recorded, if necessary, based on the method previously described. Cost reports must generally be filed within five months after the end of the annual cost report reporting period. After the cost report is filed, the accrual and corresponding valuation allowance may need to be adjusted. Settlements with third‑party payers for retroactive revenue adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care using the most likely outcome method. These settlements are estimated based on the terms of the payment agreement with the payer, correspondence from the payer and our historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Because the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates we record could change by material amounts. Private Insurance— Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per‑diem rates, discounted FFS rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers, which can take several years before they are completely resolved. The payers are billed for patient services on an individual patient basis. An individual patient’s bill is subject to adjustment on a patient‑by‑patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. We estimate the discounts for contractual allowances at the individual hospital level utilizing billing data on an individual patient basis. At the end of each month, on an individual hospital basis, we estimate our expected reimbursement for patients of managed care plans based on the applicable contract terms. Contractual allowance estimates are periodically reviewed for accuracy by taking into consideration known contract terms, as well as payment history. We believe our estimation and review process enables us to identify instances on a timely basis where such estimates need to be revised. We do not believe there were any adjustments to estimates of patient bills that were material to our revenues during the years ended December 31, 2023, 2022 or 2021. In addition, on a corporate‑wide basis, we do not record any general provision for adjustments to estimated contractual allowances for managed care plans. Managed care accounts, net of contractual allowances recorded, are further reduced to their net realizable value through implicit price concessions based on historical collection trends for these payers and other factors that affect the estimation process. We know of no claims, disputes or unsettled matters with any payer that would materially affect our revenues for which we have not adequately provided in the accompanying Consolidated Financial Statements. Uninsured Patients— Generally, patients who are covered by third‑party payers are responsible for related co‑pays, co‑insurance and deductibles, which vary in amount. We also provide services to uninsured patients and offer uninsured patients a discount from standard charges. We estimate the transaction price for patients with co‑pays, co‑insurance and deductibles and for those who are uninsured based on historical collection experience and current market conditions. Under our Compact and other uninsured discount programs, the discount offered to certain uninsured patients is recognized as a contractual allowance, which reduces net operating revenues at the time the self‑pay accounts are recorded. The uninsured patient accounts, net of contractual allowances recorded, are further reduced to their net realizable value at the time they are recorded through implicit price concessions based on historical collection trends for self‑pay accounts and other factors that affect the estimation process. Implicit Price Concessions— We record implicit price concessions, primarily related to uninsured patients and patients with co‑pays, co‑insurance and deductibles. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts we expect to collect based on our collection history with similar patients. Although outcomes vary, our policy is to attempt to collect amounts due from patients, including co‑pays, co‑insurance and deductibles due from patients with insurance, at the time of service while complying with all federal and state statutes and regulations, including, but not limited to, the Emergency Medical Treatment and Active Labor Act (“EMTALA”). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, services, including the legally required medical screening examination and stabilization of the patient, are performed without delaying to obtain insurance information. In non‑emergency circumstances or for elective procedures and services, it is our policy to verify insurance prior to a patient being treated; however, there are various exceptions that can occur. Such exceptions can include, for example, instances where (1) we are unable to obtain verification because the patient’s insurance company was unable to be reached or contacted, (2) a determination is made that a patient may be eligible for benefits under various government programs, such as Medicaid or Victims of Crime, and it takes several days or weeks before qualification for such benefits is confirmed or denied, and (3) under physician orders we provide services to patients that require immediate treatment. There are various factors that can impact collection trends, such as: changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients; the volume of patients through our emergency departments; the increased burden of co‑pays, co‑insurance amounts and deductibles to be made by patients with insurance; and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and our estimation process. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenues in the period of the change. We also provide charity care to patients who are financially unable to pay for the healthcare services they receive. Most patients who qualify for charity care are charged a per‑diem amount for services received, subject to a cap. Except for the per‑diem amounts, our policy is not to pursue collection of amounts determined to qualify as charity care; therefore, we do not report these amounts in net operating revenues. Patient advocates from our Eligibility and Enrollment Services program screen patients in the hospital to determine whether those patients meet eligibility requirements for financial assistance programs. They also expedite the process of applying for these government programs. Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. Approximately 88% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days. Revenue Cycle Management and Other Services Our Hospital Operations segment also provides revenue cycle management and other services to health systems, individual hospitals and physician practices. We recognize revenue from our contracts when the underlying performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which we expect to be entitled. At contract inception, we assess the services specified in our contracts with customers and identify a performance obligation for each distinct contracted service. We generally consider the following distinct services as separate performance obligations: • revenue cycle management services; • value‑based care services; • patient communication and engagement services; • consulting services; and • other client‑defined projects. Our contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Long‑term contracts typically provide for the delivery of recurring monthly services over a multi‑year period. The contracts are typically priced such that our monthly fee to our customer represents the value obtained by the customer in the month for those services. Such multi‑year service contracts may have upfront fees related to transition or integration work performed by us to set up the delivery for the ongoing services. Such transition or integration work typically does not result in a separately identifiable obligation; thus, the fees and expenses related to such work are deferred and recognized over the life of the related contractual service period. For contracts in which the amortization period of the asset is one year or less, we have elected to apply the practical expedient provided by FASB ASC 340‑40‑25‑4 and expense these costs as incurred. Revenue for fixed‑priced contracts is typically recognized at the time of billing unless evidence suggests that the revenue is earned or our obligations are fulfilled in a different pattern. Revenue for volume‑based contracts is typically recognized as the services are being performed at the contractually billable rate, which is generally a percentage of collections or a percentage of client net patient revenue. Contract Assets and Liabilities— Our client contract terms, including payment conditions, are diverse. For non‑fixed‑price arrangements, we may invoice clients before we perform the contracted services, with subsequent adjustments (true‑up) to align with actual fees. In contrast, some contracts require payment after we have performed the contracted services (in arrears). Contracts may also feature performance‑based incentives or penalties, along with other variable consideration. Revenue recognition occurs when services are rendered and the client gains control or benefit of the services, regardless of the invoicing schedule, leading to the recognition of a contract asset for unbilled revenue. Unbilled revenue is recognized as receivables in the month the services are performed. Conversely, advance payments from clients result in the recognition of a contract liability for deferred revenue until the revenue recognition requirements are met. Cash and Cash Equivalents We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $1.228 billion and $858 million at December 31, 2023 and 2022, respectively. At December 31, 2023 and 2022, our book overdrafts were $187 million and $266 million, respectively, which were classified as accounts payable. At December 31, 2023 and 2022, $100 million and $140 million, respectively, of total cash and cash equivalents in the accompanying Consolidated Balance Sheets were intended for the operations of our insurance‑related subsidiaries. At December 31, 2023, 2022 and 2021, we had $154 million, $196 million and $95 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $141 million, $191 million and $88 million, respectively, were included in accounts payable. In June 2022, we acquired all of Baylor’s 5% voting ownership interest in USPI. We paid $11 million from cash on hand and recognized a liability of $377 million, the present value of the liability on the acquisition date, for the remainder of the purchase price. We recorded reductions in redeemable noncontrolling interest of $365 million for the carrying value of Baylor’s ownership interest and $23 million to additional paid-in capital for the difference between the carrying value and present value of the purchase price for the shares on the acquisition date. This has been reflected as noncash financing activity in the accompanying Consolidated Statement of Cash Flows for the year ended December 31, 2022. Payments made subsequent to the transaction’s close are reflected as cash activity within the financing section of our consolidated statements of cash flows in the respective period. See Note 18 for additional information about this transaction. Investments in Debt and Equity Securities We classify investments in debt securities as either available‑for‑sale, held‑to‑maturity or as part of a trading portfolio. Our policy is to classify investments in debt securities that may be needed for cash requirements as “available‑for‑sale.” At December 31, 2023 and 2022, we had no significant investments in debt securities classified as either held‑to‑maturity or trading. We carry debt securities classified as available‑for‑sale at fair value. We report their unrealized gains and losses, net of ta

EQUITY

EQUITY	12 Months Ended
	Dec. 31, 2023
Stockholders' Equity Note [Abstract]
EQUITY	EQUITY Nonredeemable Noncontrolling Interests Our nonredeemable noncontrolling interests balances at December 31, 2023 and 2022 in the accompanying Consolidated Statements of Changes in Equity were comprised of $185 million and $132 million, respectively, from our Hospital Operations segment, and $1.324 billion and $1.185 billion, respectively, from our Ambulatory Care segment. Our net income attributable to nonredeemable noncontrolling interests for the years ended December 31, 2023, 2022 and 2021 were comprised of $30 million, $21 million and $21 million, respectively, from our Hospital Operations segment, and $304 million, $221 million and $205 million, respectively, from our Ambulatory Care segment. Share Repurchase Program In October 2022, we announced that our board of directors had authorized the repurchase of up to $1 billion of our common stock through a share repurchase program that expires on December 31, 2024. Under the program, shares can be purchased in the open market or through privately negotiated transactions in a manner consistent with applicable securities laws and regulations, including pursuant to a Rule 10b5-1 plan if established by the Company, at times and in amounts based on market conditions and other factors. The table below summarizes transactions completed under the repurchase program during the years ended December 31, 2023 and 2022: Period Total Number of Shares Purchased Average Price Paid per Share Total Number of Shares Purchased as Part of Publicly Announced Program Maximum Dollar Value of Shares That May Yet be Purchased Under the Program (In Thousands) (In Thousands) (In Millions) Inception through October 31, 2022 1,800 $ 41.81 1,800 $ 925 November 1 through November 30, 2022 4,089 $ 42.74 4,089 $ 750 December 1 through December 31, 2022 — $ — — $ 750 Inception through December 31, 2022 5,889 $ 42.45 5,889 January 1 through January 31, 2023 — $ — — $ 750 February 1 through February 28, 2023 — $ — — $ 750 March 1 through March 31, 2023 906 $ 55.03 906 $ 700 April 1 through April 30, 2023 — $ — — $ 700 May 1 through May 31, 2023 580 $ 69.17 580 $ 660 June 1 through June 30, 2023 — $ — — $ 660 July 1 through July 31, 2023 — $ — — $ 660 August 1 through August 31, 2023 — $ — — $ 660 September 1 through September 30, 2023 — $ — — $ 660 October 1 through October 31, 2023 — $ — — $ 660 November 1 through November 30, 2023 982 $ 67.12 982 $ 594 December 1 through December 31, 2023 644 $ 68.53 644 $ 550 Year ended December 31, 2023 3,112 $ 64.27 3,112

ACCOUNTS RECEIVABLE

ACCOUNTS RECEIVABLE	12 Months Ended
	Dec. 31, 2023
Accounts Receivable Additional Disclosures [Abstract]
ACCOUNTS RECEIVABLE	ACCOUNTS RECEIVABLE The principal components of accounts receivable are shown in the table below: December 31, 2023 2022 Patient accounts receivable $ 2,719 $ 2,746 Estimated future recoveries 148 149 Net cost reports and settlements receivable and valuation allowances 47 48 Accounts receivable, net $ 2,914 $ 2,943 Patient accounts receivable, including billed accounts and certain unbilled accounts, as well as estimated amounts due from third‑party payers for retroactive adjustments, are receivables if our right to consideration is unconditional and only the passage of time is required before payment of that consideration is due. Estimated uncollectable amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable rather than allowance for doubtful accounts. We also provide financial assistance through our charity and uninsured discount programs to uninsured patients who are unable to pay for the healthcare services they receive. Our policy is not to pursue collection of amounts determined to qualify for financial assistance; therefore, we do not report these amounts in net operating revenues. Most states include an estimate of the cost of charity care in the determination of a hospital’s eligibility for Medicaid disproportionate share hospital payments. These payments are intended to mitigate our cost of uncompensated care. Some states have also developed provider fee or other supplemental payment programs to mitigate the shortfall of Medicaid reimbursement compared to the cost of caring for Medicaid patients. We participate in various provider fee programs, which help reduce the amount of uncompensated care from indigent patients and those covered by Medicaid. The following table summarizes the amount and classification of assets and liabilities in the accompanying Consolidated Balance Sheets related to California’s provider fee program: December 31, 2023 2022 Assets: Other current assets $ 329 $ 367 Investments and other assets $ 334 $ 197 Liabilities: Other current liabilities $ 172 $ 145 Other long-term liabilities $ 135 $ 63 The following table presents our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients: Years Ended December 31, 2023 2022 2021 Estimated costs for: Uninsured patients $ 499 $ 537 $ 650 Charity care patients 110 83 97 $ 609 $ 620 $ 747

CONTRACT BALANCES

CONTRACT BALANCES	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
CONTRACT BALANCES	CONTRACT BALANCES Hospital Operations Segment Our Hospital Operations segment’s contract assets and liabilities primarily derive from: (1) patients receiving ongoing inpatient care from one of our facilities at the end of the reporting period; (2) timing differences between our performance of revenue cycle management and other contractually-based services and the invoicing or receipt of payment for these services; and, with respect to the year ended December 31, 2021 as discussed below, (3) advance payments from the MAPP following its expansion under the COVID Acts. Our Hospital Operations segment’s contract assets were included in other current assets, and its contract liabilities are included in other current liabilities or other long‑term liabilities, depending upon when we expect to recognize the underlying revenue, in the accompanying Consolidated Balance Sheets at December 31, 2023 and 2022. The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows: Receivables Contract Assets – Contract Liabilities – Contract Liabilities – December 31, 2022 $ 37 $ 200 $ 110 $ 13 December 31, 2023 21 208 59 12 Increase (decrease) $ (16) $ 8 $ (51) $ (1) December 31, 2021 $ 28 $ 199 $ 955 $ 15 December 31, 2022 37 200 110 13 Increase (decrease) $ 9 $ 1 $ (845) $ (2) At December 31, 2021, the current portion of our Hospital Operations segment’s contract liabilities included $876 million of MAPP advances. All remaining MAPP advances received by our Hospital Operations segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. In the years ended December 31, 2023 and 2022, we recognized revenue totaling $71 million and $56 million, respectively, from our revenue cycle management services that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those contract clients who were billed in advance, changes in estimates related to metric‑based services and up‑front integration services that are recognized over the service period. Contract Costs— We recognized amortization expense related to deferred contract setup costs of $5 million in the year ended December 31, 2023, and $4 million in each of the years ended December 31, 2022 and 2021. At December 31, 2023 and 2022, the unamortized customer contract costs were $22 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets. Ambulatory Care Segment All remaining MAPP advances received by our Ambulatory Care segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows: Contract Liabilities – Current Advances from Medicare December 31, 2021 $ 4 December 31, 2022 — Decrease $ (4) Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact and other uninsured discount and charity programs. Net operating revenues for our Hospital Operations segment also includes revenues from providing revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. The table below presents our sources of net operating revenues: Years Ended December 31, 2023 2022 2021 Hospital Operations: Net patient service revenues from hospitals and related outpatient facilities: Medicare $ 2,383 $ 2,369 $ 2,615 Medicaid 1,233 1,069 1,254 Managed care 10,248 9,607 9,985 Uninsured 96 141 199 Indemnity and other 590 661 706 Total 14,550 13,847 14,759 Other revenues (1) 2,133 2,079 2,008 Total Hospital Operations 16,683 15,926 16,767 Ambulatory Care 3,865 3,248 2,718 Net operating revenues $ 20,548 $ 19,174 $ 19,485 (1) Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure. Revenues related to the Texas Comprehensive Hospital Increase Reimbursement Program (“CHIRP”) are presented in managed care net patient service revenues in the table above. Amounts we were assessed to support CHIRP following its approval in 2022 were presented in Medicaid revenues during that period, but have been reclassified to managed care revenues to conform to the current‑year presentation in the same payer group as the revenues to more clearly reflect the results of our participation in this program. Assessments to support CHIRP totaled $126 million and $123 million during the years ended December 31, 2023 and 2022, respectively. Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2023, 2022 and 2021 by $24 million, $10 million and $26 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Consolidated Balance Sheets (see Note 3). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid. The following table presents the composition of net operating revenues for our Ambulatory Care segment: Years Ended December 31, 2023 2022 2021 Net patient service revenues $ 3,713 $ 3,115 $ 2,604 Management fees 123 110 86 Revenue from other sources 29 23 28 Net operating revenues $ 3,865 $ 3,248 $ 2,718 Performance Obligations The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032. Years Ending December 31, Later Years Total 2024 2025 2026 2027 2028 Performance obligations $ 6,026 $ 685 $ 684 $ 683 $ 683 $ 683 $ 2,608

ASSETS AND LIABILITIES HELD FOR

ASSETS AND LIABILITIES HELD FOR SALE	12 Months Ended
	Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]
ASSETS AND LIABILITIES HELD FOR SALE	ASSETS AND LIABILITIES HELD FOR SALE In November 2023, we entered into a definitive agreement for the sale of three hospitals located in South Carolina and certain related operations (together, the “SC Hospitals”), all of which were held by our Hospital Operations segment. The assets and liabilities related to the SC Hospitals were included in assets held for sale and liabilities held for sale, respectively, in the accompanying Consolidated Balance Sheet at December 31, 2023. We received pre-tax proceeds of approximately $2.400 billion when this sale closed in January 2024. In January 2023, we entered into a definitive agreement to sell our 51% ownership interest in San Ramon Regional Medical Center and certain related operations (“San Ramon RMC”), which is held by our Hospital Operations segment, to John Muir Health (“John Muir”). We reclassified the assets and liabilities related to San Ramon RMC to assets held for sale and liabilities held for sale, respectively, in our consolidated balance sheet following our decision to sell our ownership interest. John Muir announced it no longer intended to pursue the acquisition after the U.S. Federal Trade Commission took action to challenge the transaction, following which we removed the assets and liabilities from held for sale and reclassified them as held and used in our consolidated balance sheet. We completed the sale of five Miami‑area hospitals and certain related operations (the “Miami Hospitals”) held by our Hospital Operations segment in August 2021, resulting in our recognition of a pre‑tax gain on sale of $406 million in the year ended December 31, 2021. In the three months ended June 30, 2021, we completed the sale of the majority of our UCCs operated under the MedPost and CareSpot brands by our Hospital Operations and Ambulatory Care segments, and we also completed the separate sale of a Philadelphia‑area building held by our Hospital Operations segment. We recorded a gain related to the sale of the UCCs of $14 million and a gain of $2 million related to the sale of the building in Philadelphia in 2021. Gains related to the sales described above were included in net gains on sales, consolidation and deconsolidation of facilities in the accompanying Consolidated Statement of Operations for the year ended December 31, 2021. No impairment charge was incurred during the years ended December 31, 2023, 2022 or 2021 related to planned divestitures. Assets and liabilities classified as held for sale at December 31, 2023 were comprised of the following: Accounts receivable $ 78 Other current assets 25 Investments and other long-term assets 26 Property and equipment 204 Other intangible assets 17 Goodwill 425 Current liabilities (45) Long-term liabilities (24) Net assets held for sale $ 706 The following table presents amounts included in income from continuing operations, before income taxes, related to significant components of our business that were recently disposed of or were classified as held for sale at December 31, 2023: Years Ended December 31, 2023 2022 2021 Significant disposals: Income (loss) from continuing operations, before income taxes: Miami Hospitals (includes a $406 million gain on sale in 2021) $ (3) $ 10 $ 455 Significant planned divestitures classified as held for sale: Income from continuing operations, before income taxes: SC Hospitals $ 130 $ 127 $ 135

IMPAIRMENT AND RESTRUCTURING CH

IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS	12 Months Ended
	Dec. 31, 2023
Restructuring Costs and Asset Impairment Charges [Abstract]
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS	IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS We recognized impairment charges on certain assets in 2023, 2022 and 2021 because the fair values of those assets or groups of assets indicated that the carrying amount was not recoverable. The fair value estimates were derived from third‑party appraisals, established market values of comparable assets, or internally developed estimates of future net cash flows. These fair value estimates can change by material amounts in subsequent periods. Many factors and assumptions can impact the estimates, including the future financial results of the facilities, how the facilities are operated in the future, changes in healthcare industry trends and regulations, and the nature of the ultimate disposition of the assets. In certain cases, these fair value estimates assume the highest and best use of facility assets in the future to a marketplace participant is other than as a medical facility. In these cases, the estimates are based on the fair value of the real property and equipment if utilized other than as a medical facility. The impairment recognized does not include the costs of closing the facilities or other future operating costs, which could be substantial. Accordingly, the ultimate net cash realized from the facilities, should we choose to sell them, could be significantly less than their impaired value. Our impairment tests presume stable, improving or, in some cases, declining operating results in our facilities, which are based on programs and initiatives being implemented that are designed to achieve each facility’s most recent projections. If these projections are not met, or negative trends occur that impact our future outlook, future impairments of long-lived assets and goodwill may occur, and we may incur additional restructuring charges, which could be material. Our reporting segments are the reporting units used to perform our goodwill analysis. At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. As discussed in Note 1, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations) during the three months ended December 31, 2023. We performed our annual goodwill impairment analysis as of October 1, 2023 based on our three separate reporting segments. We performed an additional goodwill impairment analysis as of December 31, 2023, following the combination of our Hospital Operations and other and Conifer segments, based on our new two-segment structure. Neither of the impairment analyses resulted in the identification of a goodwill impairment. We periodically incur costs to implement restructuring efforts for specific operations, which are recorded in our statement of operations as they are incurred. Our restructuring plans focus on various aspects of operations, including aligning our operations in the most strategic and cost‑effective structure, such as the establishment of support operations at our GBC. Certain restructuring and acquisition‑related costs are based on estimates. Changes in estimates are recognized as they occur. Year Ended December 31, 2023 During the year ended December 31, 2023, we recorded impairment and restructuring charges and acquisition‑related costs of $137 million, consisting of $79 million of restructuring charges, $43 million of impairment charges and $15 million of acquisition‑related transaction costs. Impairment charges for the year ended December 31, 2023 primarily arose from the write‑down of our investment in certain equity method investments held by our Ambulatory Care segment. Restructuring charges consisted of $36 million of legal costs related to the sale of certain businesses, $15 million of employee severance costs, $12 million related to the transition of various administrative functions to our GBC, $10 million of contract and lease termination fees, and $6 million of other restructuring costs. Year Ended December 31, 2022 During the year ended December 31, 2022, we recorded impairment and restructuring charges and acquisition‑related costs of $226 million, consisting of $118 million of restructuring charges, $94 million of impairment charges and $14 million of acquisition‑related transaction costs. Impairment charges included $82 million for the write‑down of certain buildings and medical equipment located in one of our markets to their estimated fair values, which assets are part of our Hospital Operations segment. Material adverse trends in our estimates of future undiscounted cash flows of the hospitals indicated the aggregate carrying value of the hospitals’ long‑lived assets was not recoverable from their estimated future cash flows. We believe the most significant factors contributing to the adverse financial trends included decreased revenues and lower patient volumes due to the pandemic and competition, as well as higher labor costs because of the pandemic. As a result, we updated the estimate of the fair value of the hospitals’ long‑lived assets and compared it to the aggregate carrying value of those assets. Because the fair value estimates were lower than the aggregate carrying value of the long‑lived assets, an impairment charge was recorded for the difference in the amounts. The aggregate carrying value of the hospitals’ assets held and used for which impairment charges were recorded was $167 million at December 31, 2022. Impairment charges for the year ended December 31, 2022 were comprised of $88 million from our Hospital Operations segment and $6 million from our Ambulatory Care segment. Restructuring charges consisted of $27 million of employee severance costs, $16 million related to the transition of various administrative functions to our GBC, $32 million of contract and lease termination fees, and $43 million of other restructuring costs. Year Ended December 31, 2021 During the year ended December 31, 2021, we recorded impairment and restructuring charges and acquisition‑related costs of $85 million, consisting of $57 million of restructuring charges, $8 million of impairment charges and $20 million of acquisition‑related costs. Restructuring charges consisted of $14 million of employee severance costs, $19 million related to the transition of various administrative functions to our GBC and $24 million of other restructuring costs. Our impairment charges for the year ended December 31, 2021, comprised of $5 million from our Ambulatory Care segment and $3 million from our Hospital Operations segment, primarily consisted of charges to reduce the carrying value of certain management contract intangible assets held by our Ambulatory Care segment to their estimated fair value. Acquisition‑related costs for the year ended December 31, 2021 consisted of $20 million of transaction costs.

LEASES

LEASES	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
LEASES	LEASES The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets: December 31, Component of Lease Balances Classification in Consolidated Balance Sheets 2023 2022 Assets: Operating lease assets Investments and other assets $ 1,083 $ 1,129 Finance lease assets Property and equipment, at cost, less accumulated depreciation and amortization 253 303 Total leased assets $ 1,336 $ 1,432 Liabilities: Operating lease liabilities: Current Other current liabilities $ 204 $ 207 Long-term Other long-term liabilities 1,007 1,046 Total operating lease liabilities 1,211 1,253 Finance lease liabilities: Current Current portion of long-term debt 84 99 Long-term Long-term debt, net of current portion 120 165 Total finance lease liabilities 204 264 Total lease liabilities $ 1,415 $ 1,517 The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations: Component of Lease Expense Classification in Consolidated Statements of Operations Years Ended December 31, 2023 2022 2021 Operating lease expense Other operating expenses, net $ 259 $ 262 $ 241 Finance lease expense: Amortization of leased assets Depreciation and amortization 55 58 71 Interest on lease liabilities Interest expense 8 8 9 Total finance lease expense 63 66 80 Variable and short term-lease expense Other operating expenses, net 159 150 171 Total lease expense $ 481 $ 478 $ 492 The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table: Years Ended December 31, 2023 2022 2021 Weighted-average remaining lease term (years): Operating leases 7.6 8.0 7.5 Finance leases 6.0 5.5 5.7 Weighted-average discount rate: Operating leases 5.0 % 4.8 % 5.1 % Finance leases 6.5 % 5.9 % 5.4 % Cash flow and other information related to leases is included in the following table: Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash outflows from operating leases $ 258 $ 250 $ 237 Operating cash outflows from finance leases $ 13 $ 14 $ 12 Financing cash outflows from finance leases $ 107 $ 118 $ 140 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 168 $ 341 $ 176 Finance leases $ 55 $ 97 $ 136 Future maturities of lease liabilities at December 31, 2023 are presented in the following table: Operating Leases Finance Leases Total 2024 $ 255 $ 95 $ 350 2025 225 54 279 2026 190 24 214 2027 165 9 174 2028 136 7 143 Later years 494 70 564 Total lease payments 1,465 259 1,724 Less: Imputed interest 254 55 309 Total lease obligations 1,211 204 1,415 Less: Current obligations 204 84 288 Long-term lease obligations $ 1,007 $ 120 $ 1,127 During the three months ended March 31, 2022, we sold several medical office buildings held in our Hospital Operations segment for net cash proceeds of $147 million and concurrently entered into operating lease agreements to continue use of the facilities. We recognized a gain of $69 million from the sale of these buildings, included in other operating expenses, net in the accompanying Consolidated Statement of Operations, and we recognized right-of-use assets and operating lease obligations of $103 million, in each case in the three months ended March 31, 2022.
LEASES	LEASES The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets: December 31, Component of Lease Balances Classification in Consolidated Balance Sheets 2023 2022 Assets: Operating lease assets Investments and other assets $ 1,083 $ 1,129 Finance lease assets Property and equipment, at cost, less accumulated depreciation and amortization 253 303 Total leased assets $ 1,336 $ 1,432 Liabilities: Operating lease liabilities: Current Other current liabilities $ 204 $ 207 Long-term Other long-term liabilities 1,007 1,046 Total operating lease liabilities 1,211 1,253 Finance lease liabilities: Current Current portion of long-term debt 84 99 Long-term Long-term debt, net of current portion 120 165 Total finance lease liabilities 204 264 Total lease liabilities $ 1,415 $ 1,517 The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations: Component of Lease Expense Classification in Consolidated Statements of Operations Years Ended December 31, 2023 2022 2021 Operating lease expense Other operating expenses, net $ 259 $ 262 $ 241 Finance lease expense: Amortization of leased assets Depreciation and amortization 55 58 71 Interest on lease liabilities Interest expense 8 8 9 Total finance lease expense 63 66 80 Variable and short term-lease expense Other operating expenses, net 159 150 171 Total lease expense $ 481 $ 478 $ 492 The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table: Years Ended December 31, 2023 2022 2021 Weighted-average remaining lease term (years): Operating leases 7.6 8.0 7.5 Finance leases 6.0 5.5 5.7 Weighted-average discount rate: Operating leases 5.0 % 4.8 % 5.1 % Finance leases 6.5 % 5.9 % 5.4 % Cash flow and other information related to leases is included in the following table: Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash outflows from operating leases $ 258 $ 250 $ 237 Operating cash outflows from finance leases $ 13 $ 14 $ 12 Financing cash outflows from finance leases $ 107 $ 118 $ 140 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 168 $ 341 $ 176 Finance leases $ 55 $ 97 $ 136 Future maturities of lease liabilities at December 31, 2023 are presented in the following table: Operating Leases Finance Leases Total 2024 $ 255 $ 95 $ 350 2025 225 54 279 2026 190 24 214 2027 165 9 174 2028 136 7 143 Later years 494 70 564 Total lease payments 1,465 259 1,724 Less: Imputed interest 254 55 309 Total lease obligations 1,211 204 1,415 Less: Current obligations 204 84 288 Long-term lease obligations $ 1,007 $ 120 $ 1,127 During the three months ended March 31, 2022, we sold several medical office buildings held in our Hospital Operations segment for net cash proceeds of $147 million and concurrently entered into operating lease agreements to continue use of the facilities. We recognized a gain of $69 million from the sale of these buildings, included in other operating expenses, net in the accompanying Consolidated Statement of Operations, and we recognized right-of-use assets and operating lease obligations of $103 million, in each case in the three months ended March 31, 2022.

LONG-TERM DEBT

LONG-TERM DEBT	12 Months Ended
	Dec. 31, 2023
Long-Term Debt and Lease Obligation [Abstract]
LONG-TERM DEBT	LONG-TERM DEBT The table below presents our long‑term debt included in the accompanying Consolidated Balance Sheets: December 31, 2023 2022 Senior unsecured notes: 6.125% due 2028 $ 2,500 $ 2,500 6.875% due 2031 362 362 Senior secured first lien notes: 4.625% due July 2024 — 756 4.625% due September 2024 — 589 4.875% due 2026 2,100 2,100 5.125% due 2027 1,500 1,500 4.625% due 2028 600 600 4.250% due 2029 1,400 1,400 4.375% due 2030 1,450 1,450 6.125% due 2030 2,000 2,000 6.750% due 2031 1,350 — Senior secured second lien notes: 6.250% due 2027 1,500 1,500 Finance leases, mortgages and other notes 361 453 Unamortized issue costs and note discounts (121) (131) Long-term debt 15,002 15,079 Less: Current portion 120 145 Long-term debt, net of current portion $ 14,882 $ 14,934 Senior Unsecured Notes and Senior Secured Notes At December 31, 2023, we had senior unsecured notes and senior secured notes with aggregate principal amounts outstanding of $14.762 billion. These notes have fixed interest rates ranging from 4.250% to 6.875% and require semi‑annual interest payments in arrears. A payment of the principal and any accrued but unpaid interest is due upon the maturity date of the respective notes, which dates are staggered from January 2026 through November 2031. We completed the following transactions related to our senior secured notes during the years ended December 31, 2023 and 2022. 2023 Transactions: • In May 2023, we issued $1.350 billion aggregate principal amount of 6.750% senior secured first lien notes, which will mature on May 15, 2031 (the “2031 Senior Secured First Lien Notes”). We pay interest on the 2031 Senior Secured First Lien Notes semi-annually in arrears on May 15 and November 15 of each year, which payments commenced on November 15, 2023. We used the issuance proceeds, together with cash on hand, to finance the redemption of our 4.625% senior secured first lien notes due September 2024 (the “September 2024 Senior Secured First Lien Notes”) and our 4.625% senior secured first lien notes due July 2024 (the “July 2024 Senior Secured First Lien Notes”), as described below. • Also in May 2023, we paid $596 million using a portion of the proceeds from the issuance of our 2031 Senior Secured First Lien Notes to redeem all $589 million aggregate principal amount outstanding of our September 2024 Senior Secured First Lien Notes in advance of their maturity date. • In June 2023, we used the remaining proceeds from the issuance of our 2031 Senior Secured First Lien Notes along with cash on hand to redeem all $756 million aggregate principal amount outstanding of our July 2024 Senior Secured First Lien Notes in advance of their maturity date. 2022 Transactions: • On February 23, 2022, we redeemed all $700 million aggregate principal amount outstanding of our 7.500% senior secured first lien notes due 2025 in advance of their maturity date. We paid $730 million from cash on hand to redeem the notes. • On June 15, 2022, we issued $2.000 billion aggregate principal amount of 6.125% senior secured first lien notes, which will mature on June 15, 2030 (the “2030 Senior Secured First Lien Notes”). We pay interest on the 2030 Senior Secured First Lien Notes semi‑annually in arrears on June 15 and December 15 of each year, which payments commenced in December 2022. As further discussed below, we used a substantial portion of the issuance proceeds from the 2030 Senior Secured First Lien Notes, after payment of fees and expenses, to finance the redemption of our 6.750% senior unsecured notes due 2023 (the “2023 Senior Unsecured Notes”). • Through a series of open‑market transactions during the six months ended June 30, 2022, we repurchased $124 million aggregate principal amount outstanding of our 2023 Senior Unsecured Notes using cash on hand. Following the issuance of our 2030 Senior Secured First Lien Notes, we used a substantial portion of the proceeds to redeem the then-remaining $1.748 billion aggregate principal outstanding of the 2023 Senior Unsecured Notes in advance of their maturity date. In total, we paid $1.933 billion during the six months ended June 30, 2022 to retire all $1.872 billion aggregate principal amount outstanding of our 2023 Senior Unsecured Notes. • During the three months ended December 31, 2022, we paid a total of $13 million from cash on hand through multiple open‑market transactions to repurchase $14 million of the $770 million aggregate principal amount then outstanding of our July 2024 Senior Secured First Lien Notes in advance of their maturity date. • Also during the three months ended December 31, 2022, we repurchased $11 million of the then‑remaining $600 million aggregate principal amount outstanding of our September 2024 Senior Secured First Lien Notes in advance of their maturity date. We made aggregate payments of $11 million from cash on hand through multiple open‑market transactions to repurchase these notes. We recorded net losses from the early extinguishment of debt of $11 million and $109 million in connection with the aforementioned purchases and redemptions during the years ended December 31, 2023 and 2022, respectively. The losses recognized during both periods primarily related to the differences between the purchase or redemption prices and the par values of the notes, as well as the write‑off of associated unamortized issuance costs. All of our senior secured notes are guaranteed by certain of our wholly owned domestic hospital company subsidiaries and secured by a pledge of the capital stock and other ownership interests of those subsidiaries on either a first lien or second lien basis, as indicated in the table above. All of our senior secured notes and the related subsidiary guarantees are our and the subsidiary guarantors’ senior secured obligations. All of our senior secured notes rank equally in right of payment with all of our other senior secured indebtedness. Our senior secured notes rank senior to any subordinated indebtedness that we or such subsidiary guarantors may incur; they are effectively senior to our and such subsidiary guarantors’ existing and future unsecured indebtedness and other liabilities to the extent of the value of the collateral securing the notes and the subsidiary guarantees; they are effectively subordinated to our and such subsidiary guarantors’ obligations under our senior secured revolving credit facility (as amended to date, the “Credit Agreement”) to the extent of the value of the collateral securing borrowings thereunder; and they are structurally subordinated to all obligations of our non‑guarantor subsidiaries. The indentures setting forth the terms of our senior secured notes contain provisions governing our ability to redeem the notes and the terms by which we may do so. At our option, we may redeem our senior secured notes, in whole or in part, at any time at a redemption price equal to 100% of the principal amount of the notes redeemed plus the make‑whole premium set forth in the related indenture, together with accrued and unpaid interest thereon, if any, to the redemption date. Certain series of the senior secured notes may also be redeemed, in whole or in part, at certain redemption prices set forth in the applicable indentures, together with accrued and unpaid interest. In addition, we may be required to purchase for cash all or any part of each series of our senior secured notes upon the occurrence of a change of control (as defined in the applicable indentures) for a cash purchase price of 101% of the aggregate principal amount of the notes, plus accrued and unpaid interest. All of our senior unsecured notes are general unsecured senior debt obligations that rank equally in right of payment with all of our other unsecured senior indebtedness, but are effectively subordinated to our senior secured notes described above, the obligations of our subsidiaries and any obligations under our Credit Agreement to the extent of the value of the collateral. We may redeem any series of our senior unsecured notes, in whole or in part, at any time at a redemption price equal to 100% of the principal amount of the notes redeemed, plus a make‑whole premium specified in the applicable indenture, if any, together with accrued and unpaid interest to the redemption date. Credit Agreement Our Credit Agreement provides for revolving loans in an aggregate principal amount of up to $1.500 billion with a $200 million subfacility for standby letters of credit. In April 2021, we amended the Credit Agreement to, among other things, extend the incremental borrowing capacity made temporarily available to us beginning in April 2020 (the “Increased Commitments”), which was schedule to expire in April 2021, through April 2022 and reduce the interest rate margins. In March 2022, we further amended our Credit Agreement to, among other things, (1) decrease the aggregate revolving credit commitments from the previous Increased Commitments to aggregate revolving credit commitments not to exceed $1.500 billion, subject to borrowing availability, (2) extend the scheduled maturity date to March 16, 2027, and (3) replace the London Interbank Offered Rate (“LIBOR”) as the reference interest rate. At December 31, 2023, we had no cash borrowings outstanding under the Credit Agreement, and we had less than $1 million of standby letters of credit outstanding. Based on our eligible receivables, $1.500 billion was available for borrowing at December 31, 2023. Outstanding revolving loans accrue interest depending on the type of loan at either (a) a base rate plus an applicable margin ranging from 0.25% to 0.75% per annum or (b) Term Secured Overnight Financing Rate (“SOFR”), Daily Simple SOFR or the Euro Interbank Offered Rate (EURIBOR) (each, as defined in the Credit Agreement) plus an applicable margin ranging from 1.25% to 1.75% per annum and (in the case of Term SOFR and Daily Simple SOFR only) a credit spread adjustment of 0.10%, in each case based on available credit. An unused commitment fee payable on the undrawn portion of the revolving loans ranges from 0.25% to 0.375% per annum based on available credit. Our borrowing availability is based on a specified percentage of eligible inventory and accounts receivable, including self‑pay accounts. Obligations under the Credit Agreement continue to be guaranteed by substantially all of our domestic wholly owned hospital subsidiaries and secured by a first‑priority lien on the eligible inventory and accounts receivable owned by us and the subsidiary guarantors, including receivables for Medicaid supplemental payments. Letter of Credit Facility We have a letter of credit facility (as amended to date, the “LC Facility”) that provides for the issuance, from time to time, of standby and documentary letters of credit in an aggregate principal amount of up to $200 million. We amended the LC Facility in September 2023 to, among other things, (1) extend the scheduled maturity date from September 12, 2024 to March 16, 2027, and (2) replace LIBOR with Term SOFR as the reference interest rate. Drawings under any letter of credit issued under the LC Facility that we have not reimbursed within three business days after notice thereof accrue interest at a base rate, as defined in the LC Facility, plus a margin of 0.50% per annum. An unused commitment fee is payable at an initial rate of 0.25% per annum with a step up to 0.375% per annum should our secured‑debt‑to‑EBITDA ratio equal or exceed 3.00 to 1.00 at the end of any fiscal quarter. A fee on the aggregate outstanding amount of issued but undrawn letters of credit accrues at a rate of 1.50% per annum. An issuance fee equal to 0.125% per annum of the aggregate face amount of each outstanding letter of credit is payable to the account of the issuer of the related letter of credit. The LC Facility is subject to an effective maximum secured debt covenant of 4.25 to 1.00. Obligations under the LC Facility are guaranteed and secured by a first‑priority pledge of the capital stock and other ownership interests of certain of our wholly owned domestic hospital subsidiaries on an equal‑ranking basis with our senior secured first lien notes. At December 31, 2023, we had $111 million of standby letters of credit outstanding under the LC Facility and were in compliance with all applicable covenants and conditions. Covenants Senior Secured Notes —The indentures governing our senior secured notes contain covenants that, among other things, restrict our ability and the ability of our subsidiaries to incur liens, consummate asset sales, enter into sale and lease‑back transactions or consolidate, merge or sell all or substantially all of our or their assets, other than in certain transactions between one or more of our wholly owned subsidiaries. These restrictions, however, are subject to a number of exceptions and qualifications. In particular, there are no restrictions on our ability or the ability of our subsidiaries to incur additional indebtedness, make restricted payments, pay dividends or make distributions in respect of capital stock, purchase or redeem capital stock, enter into transactions with affiliates or make advances to, or invest in, other entities (including unaffiliated entities). In addition, the indentures governing our senior secured notes contain a covenant that neither we nor any of our subsidiaries will incur secured debt, unless at the time of and after giving effect to the incurrence of such debt, the aggregate amount of all such secured debt (including the aggregate principal amount of senior secured notes outstanding and any outstanding borrowings under our Credit Agreement at such time) does not exceed the amount that would cause the secured debt ratio (as defined in the indentures) to exceed 4.00 to 1.00. Senior Unsecured Notes —The indentures governing our senior unsecured notes contain covenants and conditions that have, among other requirements, limitations on (1) liens on “principal properties” and (2) sale and lease‑back transactions with respect to principal properties. A principal property is defined in the senior unsecured notes indentures as a hospital that has an asset value on our books in excess of 5% of our consolidated net tangible assets, as defined in such indentures. The above limitations do not apply, however, to (1) debt that is not secured by principal properties or (2) debt that is secured by principal properties if the aggregate of such secured debt does not exceed 15% of our consolidated net tangible assets, as further described in the indentures. The senior unsecured notes indentures also prohibit the consolidation, merger or sale of all or substantially all assets unless no event of default would result after giving effect to such transaction. Credit Agreement —Our Credit Agreement contains customary covenants for an asset‑backed facility, including a minimum fixed charge coverage ratio to be met if the designated excess availability under the revolving credit facility falls below $150 million, as well as limits on debt, asset sales and prepayments of certain other debt. The Credit Agreement also includes a provision, which we believe is customary in receivables‑backed credit facilities, that gives our lenders the right to require that proceeds of collections of substantially all of our consolidated accounts receivable be applied directly to repay outstanding loans and other amounts that are due and payable under the Credit Agreement at any time that unused borrowing availability under the revolving credit facility is less than $150 million for three Future Maturities Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2023: Years Ending December 31, Later Years Total 2024 2025 2026 2027 2028 Long-term debt, including finance lease obligations $ 15,123 $ 120 $ 92 $ 2,149 $ 3,029 $ 3,114 $ 6,619

GUARANTEES

GUARANTEES	12 Months Ended
	Dec. 31, 2023
Guarantees [Abstract]
GUARANTEES	GUARANTEES Consistent with our policy on physician relocation and recruitment, we provide income guarantee agreements to certain physicians who agree to relocate to fill a community need in the service area of one of our hospitals and commit to remain in practice in the area for a specified period of time. Under such agreements, we are required to make payments to the physicians in excess of the amounts they earn in their practices up to the amount of the income guarantee. The income guarantee periods are typically 12 months. If a physician does not fulfill his or her commitment period to the community, which is typically three years subsequent to the guarantee period, we seek recovery of the income guarantee payments from the physician on a prorated basis. We also provide revenue collection guarantees to hospital‑based physician groups providing certain services at our hospitals with terms generally ranging from one At December 31, 2023, the maximum potential amount of future payments under our income guarantees to certain physicians who agree to relocate and revenue collection guarantees to hospital‑based physician groups providing certain services at our hospitals was $356 million. We had a total liability of $274 million recorded for these guarantees included in other current liabilities in the accompanying Consolidated Balance Sheet at December 31, 2023. At December 31, 2023, we also had issued guarantees of the indebtedness and other obligations of our investees to third parties, the maximum potential amount of future payments under which was approximately $88 million. Of the total, $21 million relates to the obligations of consolidated subsidiaries, which obligations were recorded in other current liabilities in the accompanying Consolidated Balance Sheet at December 31, 2023.

EMPLOYEE BENEFIT PLANS

EMPLOYEE BENEFIT PLANS	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
EMPLOYEE BENEFIT PLANS	EMPLOYEE BENEFIT PLANS Share-Based Compensation Plans We have granted stock options and restricted stock units (“RSUs”) to certain of our employees and directors pursuant to our stock incentive plans. Stock options have an exercise price equal to the fair market value of the shares on the date of grant and generally expire 10 years from the date of grant. An RSU is a contractual right to receive one share of our common stock in the future, and the fair value of the RSU is based on our share price on the grant date. Typically, stock options and time‑based RSUs vest one‑third on each of the first three We also grant performance‑based RSUs that vest subject to the achievement of specified performance goals within a specified time frame. The performance‑based RSUs may contain provisions that increase or decrease the number of RSUs that ultimately vest, depending upon the level of achievement. For certain of our performance‑based awards, the number of options or RSUs that ultimately vest is also subject to adjustment based on the achievement of a market‑based condition. These adjustments generally range from 0% to 200% of the number of RSUs initially granted for awards made prior to December 31, 2022, and from 0% to 225% for certain awards granted after that date. The fair value of awards that contain a market‑based condition is estimated using a discrete model to analyze the fair value of the subject shares. The discrete model utilizes multiple stock paths, through the use of a Monte Carlo simulation, which paths are then analyzed to determine the fair value of the subject shares. Pursuant to the terms of our stock‑based compensation plans, awards granted under the plan vest and may be exercised as determined by the human resources committee of our board of directors. In the event of a change in control, the human resources committee of our board of directors may, at its sole discretion without obtaining shareholder approval, accelerate the vesting or performance periods of the awards. At December 31, 2023, assuming outstanding performance‑based RSUs for which performance has not yet been determined will achieve target performance, approximately 8,895 thousand shares of common stock were available under our 2019 Stock Incentive Plan for future stock option grants and other equity incentive awards, including RSUs. The accompanying Consolidated Statements of Operations include pre-tax compensation costs related to our stock‑based compensation arrangements of $66 million for the year ended December 31, 2023, and $56 million for each of the years ended December 31, 2022 and 2021. Stock Options The following table summarizes stock option activity during the years ended December 31, 2023, 2022 and 2021: Number of Options Wtd. Avg. Aggregate Wtd. Avg (In Millions) Outstanding at December 31, 2020 912,531 $ 22.51 Exercised (391,533) $ 20.66 Outstanding at December 31, 2021 520,998 $ 23.90 Exercised (60,051) $ 28.26 Outstanding at December 31, 2022 460,947 $ 23.33 Exercised (76,507) $ 26.07 Outstanding at December 31, 2023 384,440 $ 22.79 $ 20 4.1 years The stock options exercised during both of the years ended December 31, 2023 and 2022 had aggregate intrinsic values of $4 million, and the stock options exercised during the year ended December 31, 2021 had an aggregate intrinsic value of $15 million. No stock options were granted during the years ended December 31, 2023, 2022 or 2021, and all outstanding options were vested and exercisable at December 31, 2023. The following table summarizes information about our outstanding stock options at December 31, 2023: Options Outstanding and Exercisable Range of Exercise Prices Number of Wtd. Avg. Wtd. Avg. $18.99 to $20.609 255,845 3.6 years $ 19.62 $20.61 to $35.430 128,595 5.1 years $ 29.07 384,440 4.1 years $ 22.79 As of December 31, 2023, 30.8% of all our outstanding options were held by current employees and 69.2% were held by former employees. All of our outstanding options were in‑the‑money, that is, they had exercise price less than the $75.57 market price of our common stock on December 31, 2023. Restricted Stock Units The following table summarizes RSU activity during the years ended December 31, 2023, 2022 and 2021: Restricted Wtd. Avg. Grant Date Fair Unvested at December 31, 2020 2,095,206 $ 25.87 Granted 900,018 $ 58.61 Vested (765,814) $ 30.51 Forfeited (58,208) $ 37.60 Unvested at December 31, 2021 2,171,202 $ 40.51 Granted 641,205 $ 80.79 Vested (1,187,384) $ 37.18 Forfeited (104,605) $ 53.58 Unvested at December 31, 2022 1,520,418 $ 66.36 Granted 759,590 $ 60.88 Performance-based adjustment 185,901 $ 48.97 Vested (954,401) $ 48.75 Forfeited (90,445) $ 64.61 Unvested at December 31, 2023 1,421,063 $ 66.46 The table below summarizes the time-based RSUs granted during the year ended December 31, 2023: No. of RSUs Granted Vesting Terms 309,282 RSUs will vest and be settled ratably over a three 42,626 RSUs will vest and be settled on the fifth anniversary of the grant date 42,100 RSUs granted to our non-employee directors for the 2023-2024 board service year, which vested immediately and will be settled on the third anniversary of the grant date 33,586 RSUs vested and settled in December 2023 20,707 RSUs will vest and be settled upon the relocation of one of our executive officers 2,007 RSUs will vest and be settled on the third anniversary of the grant date The table below summarizes the performance-based RSUs granted during the year ended December 31, 2023: No. of RSUs Granted Performance Period Potential Vesting Range Vesting Terms Minimum Maximum 301,562 RSUs will vest and be settled on the third anniversary of the grant date 2023 to 2025 — % 225 % 185,901 RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2020 7,720 RSUs will vest and be settled on the third anniversary of the grant date 2023 to 2025 — % 200 % The table below summarizes the time-based RSUs granted during the year ended December 31, 2022: No. of RSUs Granted Vesting Terms 237,381 RSUs will vest and be settled ratably over a three 53,716 RSUs were scheduled to vest and be settled ratably over 11 quarterly periods 35,482 RSUs granted to our non-employee directors for the 2022-2023 board service year vested immediately and will be settled on the third anniversary of the grant date 9,215 RSUs will vest and be settled ratably over a four 7,325 RSUs granted to a non-executive member of the board of directors for his service as chairman of the board; award vested and settled in December 2023 6,170 RSUs will vest and be settled evenly on the third and fourth anniversaries of the grant date 4,608 RSUs will vest and be settled on the second anniversary of the grant date In addition, we granted 287,308 performance‑based RSUs during the year ended December 31, 2022; the vesting of these RSUs is contingent on our achievement of specified performance goals for the years 2022 to 2024. Provided the goals are achieved, the performance‑based RSUs will vest and be settled on the third anniversary of the grant date. The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 287,308 units granted, depending on our level of achievement with respect to the performance goals. The table below summarizes the time-based RSUs granted during the year ended December 31, 2021: No. of RSUs Granted Vesting Terms 263,180 RSUs will vest and be settled ratably over a three 189,215 RSUs were scheduled to vest and be settled ratably over eight quarterly periods from the grant date 53,341 RSUs will vest and be settled on the fourth anniversary of the grant date 38,366 RSUs granted to our non-employee directors for the 2021-2022 board service year, which vested immediately and will be settled on the third anniversary of the grant date 33,351 RSUs will vest and be settled on the third anniversary of the grant date 14,192 RSUs vested on December 31, 2021 and were settled in January 2022 8,509 RSUs, one-third of which will vest and be settled on the second anniversary of the grant date and the remainder of which will vest and be settled on the fourth anniversary 1,372 RSUs granted to a new member of our board of directors, which vested immediately and will be settled upon separation from the board The table below summarizes the performance-based RSUs granted during the year ended December 31, 2021: No. of RSUs Granted Performance Period Potential Vesting Range Vesting Terms Minimum Maximum 244,259 RSUs will vest and be settled on the third anniversary of the grant 2021 to 2023 — % 200 % 53,341 RSUs will vest and be settled on the fourth anniversary of the grant date 2021 to 2025 — % 200 % 892 RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018 Included in the 2022 and 2021 time-based RSU grants were 53,716 and 189,215 RSUs, respectively, granted to our former Executive Chairman. Furthermore, of the total 2022 performance-based RSUs, 53,716 were also granted to him. These RSUs vested and settled in October 2022, ahead of their scheduled vesting dates, in accordance with the disability provisions of our stock incentive plan. The performance-based awards vested at 100%. Compensation costs related to our stock-based compensation arrangements for the years ended December 31, 2023, 2022 and 2021 included $46 million, $45 million and $42 million of pre-tax compensation costs related to our RSUs, respectively. At December 31, 2023, there were $42 million of total unrecognized compensation costs related to RSUs. These costs are expected to be recognized over a weighted average period of 2.1 years. For certain of the performance-based RSU grants, the number of units that will ultimately vest is subject to adjustment based on the achievement of a market-based condition. The fair value of these RSUs is estimated through the use of a Monte Carlo simulation. Significant inputs used in our valuation of these RSUs included the following: Years Ended December 31, 2023 2022 2021 Expected volatility 53.6% - 65.6% 39.6% - 68.1% 65.2% - 79.3% Risk-free interest rate 4.2% - 4.8% 1.0% - 1.7% 0.1% - 0.6% USPI Management Equity Plan USPI maintains a separate restricted stock plan (the “USPI Management Equity Plan”) under which it grants RSUs representing a contractual right to receive one share of USPI’s non‑voting common stock in the future. The vesting of RSUs granted under the plan varies based on the terms of the underlying award agreement. Once the RSUs have vested and the subsequent requisite holding period is met, during specified times, the participant can sell the underlying shares to USPI at their estimated fair market value. At our sole discretion, the purchase of any non‑voting common shares can be made in cash or in shares of Tenet’s common stock. The following table summarizes RSU activity under the USPI Management Equity Plan during the years ended December 31, 2023, 2022 and 2021: Restricted Wtd. Avg. Grant Date Fair Unvested at December 31, 2020 2,025,056 $ 34.13 Granted 76,990 $ 34.13 Vested (388,588) $ 34.13 Forfeited (218,576) $ 34.13 Unvested at December 31, 2021 1,494,882 $ 34.13 Vested (369,691) $ 34.13 Forfeited (202,351) $ 34.13 Unvested at December 31, 2022 922,840 $ 34.13 Vested (303,171) $ 34.13 Forfeited (11,685) $ 34.13 Unvested at December 31, 2023 607,984 $ 34.13 USPI did not make any grants under the USPI Management Equity Plan during the years ended December 31, 2023 and 2022. During the year ended December 31, 2021, USPI granted 76,990 RSUs under its management equity plan. Twenty percent of these RSUs vests on each of the first and second anniversaries of the grant date, and the remaining 60% vests on the third anniversary of the grant date. At December 31, 2023, 607,984 RSUs were outstanding under the USPI Management Equity Plan, all of which are expected to vest. The accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021 included $20 million, $11 million and $13 million, respectively, of pre-tax compensation costs related to USPI’s management equity plan. During the years ended December 31, 2023, 2022 and 2021, USPI paid $13 million, $11 million and $9 million, respectively, to repurchase a portion of the non‑voting common stock previously issued under the USPI Management Equity Plan. At December 31, 2023, there were 51 thousand outstanding vested shares of non‑voting common stock eligible to be sold to USPI. Other Employee Benefit and Retirement Plans Employee Stock Purchase Plan We have an employee stock purchase plan under which we are currently authorized to issue up to 4,070 thousand shares of common stock to our eligible employees. As of December 31, 2023, there were approximately 2,501 thousand shares available for issuance under our employee stock purchase plan. Under the terms of the plan, eligible employees may elect to have between 1% and 10% of their base earnings withheld each quarter to purchase shares of our common stock. Shares are purchased at a price equal to 95% of the closing price on the last day of the quarter. The plan requires a one‑year holding period for all shares issued. The holding period does not apply upon termination of employment. Under the plan, no individual may purchase, in any year, shares with a fair market value in excess of $25,000. The plan is currently not considered to be compensatory. We issued the following numbers of shares under our employee stock purchase plan: Years Ended December 31, 2023 2022 2021 Number of shares (in thousands) 69 98 90 Weighted average price $ 65.62 $ 54.19 $ 63.01 Defined Contribution Retirement Plans We maintain various other defined contribution plans for the benefit of our employees. During the years ended December 31, 2023, 2022 and 2021, we incurred total expenses from these plans of $126 million, $86 million and $98 million, respectively, primarily related to our contributions to the plans. Substantially all of our employees, upon qualification, are eligible to participate in our defined contribution 401(k) plans. Under the plans, employees may contribute a portion of their eligible compensation, which we may match with employer contributions at our discretion. Employer matching contributions will vary depending on which of our subsidiaries employs the participant and whether the employee is covered under a collective bargaining agreement. Defined Benefit Retirement Plans We maintain three frozen non‑qualified defined benefit pension plans (“SERPs”) that provide supplemental retirement benefits to certain of our current and former executives. These plans are not funded, and plan obligations for these plans are paid from our working capital. Pension benefits are generally based on years of service and compensation. Upon completing the acquisition of Vanguard Health Systems, Inc. on October 1, 2013, we assumed a frozen qualified defined benefit plan (“DMC Pension Plan”) covering substantially all of the employees of our Detroit market that were hired prior to June 1, 2003. The benefits paid under the DMC Pension Plan are primarily based on years of service and final average earnings. During the year ended December 31, 2021, the Society of Actuaries issued the MP‑2021 mortality improvement scale, which we incorporated into the estimates of our defined benefit plan obligations at December 31, 2023 and 2022. The following tables summarize the balance sheet impact, as well as the benefit obligations, funded status and rate assumptions associated with the SERPs and the DMC Pension Plan based on actuarial valuations prepared: December 31, 2023 2022 Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets: Projected benefit obligations (1) Beginning obligations $ (1,002) $ (1,313) Interest cost (53) (37) Actuarial gain (loss) (15) 265 Benefits paid 84 83 Annuity purchase 36 — Special termination benefit costs (1) — Ending obligations (951) (1,002) Fair value of plans assets Beginning plan assets 648 867 Gain (loss) on plan assets 41 (161) Employer contribution — 2 Benefits paid (61) (60) Annuity purchase (36) — Ending plan assets 592 648 Funded status of plans $ (359) $ (354) Amounts recognized in the Consolidated Balance Sheets consist of: Other current liability $ (24) $ (23) Other long-term liability $ (335) $ (331) Accumulated other comprehensive loss $ 224 $ 222 SERP Assumptions: Discount rate 5.50 % 5.75 % Compensation increase rate 3.00 % 3.00 % Measurement date December 31, 2023 December 31, 2022 DMC Pension Plan Assumptions: Discount rate 5.25 % 5.51 % Compensation increase rate Frozen Frozen Measurement date December 31, 2023 December 31, 2022 (1) The accumulated benefit obligation at December 31, 2023 and 2022 was approximately $951 million and $1.002 billion, respectively. The components of net periodic benefit costs and related assumptions are as follows: Years Ended December 31, 2023 2022 2021 Interest costs $ 53 $ 37 $ 36 Expected return on plan assets (36) (42) (53) Amortization of net actuarial loss 7 9 11 Special termination benefit costs 1 — — Net periodic benefit cost (income) $ 25 $ 4 $ (6) SERP Assumptions: Discount rate 5.75 % 3.00 % 2.75 % Compensation increase rate 3.00 % 3.00 % 3.00 % Measurement date January 1, 2023 January 1, 2022 January 1, 2021 Census date January 1, 2023 January 1, 2022 January 1, 2021 DMC Pension Plan Assumptions: Discount rate 5.51 % 2.89 % 2.53 % Long-term rate of return on assets 5.75 % 5.00 % 6.25 % Compensation increase rate Frozen Frozen Frozen Measurement date January 1, 2023 January 1, 2022 January 1, 2021 Census date January 1, 2023 January 1, 2022 January 1, 2021 Net periodic benefit costs for the current year are based on assumptions determined at the valuation date of the prior year for the SERPs and the DMC Pension Plan. We recorded gain (loss) adjustments of $(2) million, $72 million and $61 million in other comprehensive income in the years ended December 31, 2023, 2022 and 2021, respectively, to recognize changes in the funded status of our SERPs and the DMC Pension Plan. Changes in the funded status are recorded as a direct increase or decrease to shareholders’ equity through accumulated other comprehensive loss. Net actuarial gains (losses) of $(9) million, $63 million and $50 million were recognized during the years ended December 31, 2023, 2022 and 2021, respectively, and the amortization of net actuarial loss of $7 million, $9 million and $11 million for the years ended December 31, 2023, 2022 and 2021, respectively, were recognized in other comprehensive income. Actuarial gains (losses) affecting the benefit obligation during the years ended December 31, 2023, 2022 and 2021 are primarily attributable to changes in the discount rate utilized for the SERP and DMC Pension Plan. Cumulative net actuarial losses totaled $224 million, $222 million and $294 million as of December 31, 2023, 2022 and 2021, respectively. There were no unrecognized prior service costs at December 31, 2023, 2022 and 2021 that had not yet been recognized as components of net periodic benefit cost. To develop the expected long‑term rate of return on plan assets assumption, the DMC Pension Plan considers the current level of expected returns on risk‑free investments (primarily government bonds), the historical level of risk premium associated with the other asset classes in which the portfolio is invested and the expectations for future returns on each asset class. The expected return for each asset class is then weighted based on the target asset allocation to develop the expected long‑term rate of return on assets assumption for the portfolio. The weighted‑average asset allocations by asset category as of December 31, 2023, were as follows: Target Actual Cash and cash equivalents — % 1 % Equity securities 20 % 6 % Debt securities 73 % 75 % Alternative investments 7 % 18 % The DMC Pension Plan assets are invested in public commingled vehicles, segregated separately managed accounts, and private commingled vehicles, all of which are managed by professional investment management firms. The objective for all asset categories is to maximize total return without assuming undue risk exposure. The DMC Pension Plan maintains a well‑diversified asset allocation that meets these objectives. The DMC Pension Plan assets are largely comprised of cash and cash equivalents, including but not limited to money market funds and repurchase agreements secured by U.S. Treasury or federal agency obligations, equity securities, including but not limited to the publicly traded shares of U.S. companies with various market capitalizations in addition to international and convertible securities, debt securities including, but not limited to, domestic and foreign government obligations, corporate bonds, and mortgage‑backed securities, and alternative investments. Alternative investments is a broadly defined asset category with the objective of diversifying the overall portfolio, complementing traditional equity and fixed‑income securities and improving the overall performance consistency of the portfolio. Alternative investments may include, but are not limited to, diversified hedge funds in the form of professionally managed pooled limited partnership investments and investments in private markets via professionally managed pooled limited partnership interests. In each investment account, the DMC Pension Plan investment managers are responsible for monitoring and reacting to economic indicators, such as gross domestic product, consumer price index and U.S. monetary policy that may affect the performance of their account. The performance of all managers and the aggregate asset allocation are formally reviewed on a quarterly basis. The current asset allocation objective is to maintain a certain percentage within each asset class allowing for deviation within the established range for each asset class. The portfolio is rebalanced on an as‑needed basis to keep these allocations within the accepted ranges. In general, fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. We consider a security that trades at least weekly to have an active market. Fair values determined by Level 2 inputs utilize data points that are observable, such as quoted prices for similar assets, interest rates and yield curves. Fair values determined by Level 3 inputs utilize unobservable data points for the asset or liability, and include situations where there is little, if any, market activity for the asset or liability. The following tables summarize the DMC Pension Plan assets measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements are determined: Total Level 1 Level 2 Level 3 As of December 31, 2023: Cash and cash equivalents $ 6 $ 6 $ — $ — Equity securities 39 39 — — Fixed income funds 442 442 — — Alternative investments: Private equity securities 97 — — 97 Hedge funds 8 — — 8 $ 592 $ 487 $ — $ 105 As of December 31, 2022: Cash and cash equivalents $ 7 $ 7 $ — $ — Equity securities 89 89 — — Debt Securities: U.S. government obligations 200 200 — — Corporate debt securities 249 249 — — Alternative investments: Private equity securities 78 — — 78 Hedge funds 25 — — 25 $ 648 $ 545 $ — $ 103 The following table presents the estimated future benefit payments to be made from the SERPs and the DMC Pension Plan, a portion of which will be funded from plan assets, for the next five years and in the aggregate for the five years thereafter: Years Ending December 31, Five Years Thereafter Total 2024 2025 2026 2027 2028 Estimated benefit payments $ 789 $ 84 $ 84 $ 83 $ 82 $ 81 $ 375 The SERP and DMC Pension Plan obligations of $359 million at December 31, 2023 are classified in the accompanying Consolidated Balance Sheet as an other current liability of $24 million and defined benefit plan obligations of $335 million based on an estimate of the expected payment patterns. We expect to make total contributions to the plans of approximately $24 million for the year ending December 31, 2024.

PROPERTY AND EQUIPMENT

PROPERTY AND EQUIPMENT	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
PROPERTY AND EQUIPMENT	PROPERTY AND EQUIPMENT The principal components of property and equipment are shown in the table below: December 31, 2023 2022 Land $ 625 $ 661 Buildings and improvements 6,692 6,646 Construction in progress 269 195 Equipment 4,750 4,748 Finance lease assets 378 413 12,714 12,663 Accumulated depreciation and amortization (6,478) (6,201) Net property and equipment $ 6,236 $ 6,462 Property and equipment is stated at cost, less accumulated depreciation and amortization and impairment write‑downs related to assets held and used. We recognized depreciation expense of $696 million, $669 million and $667 million in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively.

GOODWILL AND OTHER INTANGIBLE A

GOODWILL AND OTHER INTANGIBLE ASSETS	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL AND OTHER INTANGIBLE ASSETS	GOODWILL AND OTHER INTANGIBLE ASSETS The following table provides information on changes in the carrying amount of goodwill: December 31, 2023 2022 Hospital Operations Goodwill at beginning of period, net of accumulated impairment losses $ 3,411 $ 3,413 Goodwill acquired during the year 133 1 Goodwill related to assets held for sale and disposed (425) (3) Goodwill at end of period, net of accumulated impairment losses $ 3,119 $ 3,411 Ambulatory Care Goodwill at beginning of period $ 6,712 $ 5,848 Goodwill acquired during the year and purchase price allocation adjustments 493 866 Goodwill related to assets held for sale and disposed or deconsolidated facilities (17) (2) Goodwill at end of period $ 7,188 $ 6,712 There were $2.430 billion of accumulated impairment losses related to the goodwill of our Hospital Operations segment at both December 31, 2023 and 2022. There were no accumulated goodwill impairment losses related to our Ambulatory Care segment in either period. The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets: Gross Accumulated Net Book At December 31, 2023: Other intangible assets with finite useful lives: Capitalized software costs $ 1,712 $ (1,205) $ 507 Contracts 294 (164) 130 Other 91 (78) 13 Other intangible assets with finite lives 2,097 (1,447) 650 Other intangible assets with indefinite useful lives: Trade names 105 — 105 Contracts 609 — 609 Other 4 — 4 Other intangible assets with indefinite lives 718 — 718 Other intangible assets, net $ 2,815 $ (1,447) $ 1,368 At December 31, 2022: Other intangible assets with finite useful lives: Capitalized software costs $ 1,751 $ (1,206) $ 545 Contracts 295 (146) 149 Other 92 (76) 16 Total other intangible assets with finite lives 2,138 (1,428) 710 Other intangible assets with indefinite useful lives: Trade names 105 — 105 Contracts 603 — 603 Other 6 — 6 Total other intangible assets with indefinite lives 714 — 714 Total other intangible assets, net $ 2,852 $ (1,428) $ 1,424 Estimated future amortization of intangible assets with finite useful lives at December 31, 2023 was as follows: Total Years Ending December 31, Later Years 2024 2025 2026 2027 2028 Amortization of intangible assets $ 650 $ 132 $ 124 $ 99 $ 84 $ 61 $ 150 We recognized amortization expense of $174 million, $172 million and $188 million in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively.

OTHER ASSETS

OTHER ASSETS	12 Months Ended
	Dec. 31, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
OTHER ASSETS	OTHER ASSETS The principal components of other current assets in the accompanying Consolidated Balance Sheets were as follows: December 31, 2023 2022 Prepaid expenses $ 391 $ 400 Contract assets 208 200 California provider fee program receivables 329 367 Receivables from other government programs 282 187 Guarantees 274 143 Non-patient receivables 260 390 Other 95 88 Total other current assets $ 1,839 $ 1,775 The principal components of investments and other assets in the accompanying Consolidated Balance Sheets were as follows: December 31, 2023 2022 Marketable securities $ 48 $ 30 Equity investments in unconsolidated healthcare entities 1,512 1,599 Total investments 1,560 1,629 Cash surrender value of life insurance policies 43 37 Long-term deposits 50 56 California provider fee program receivables 334 197 Operating lease assets 1,083 1,129 Other long-term receivables and other assets 87 99 Total investments and other assets $ 3,157 $ 3,147

ACCUMULATED OTHER COMPREHENSIVE

ACCUMULATED OTHER COMPREHENSIVE LOSS	12 Months Ended
	Dec. 31, 2023
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
ACCUMULATED OTHER COMPREHENSIVE LOSS	ACCUMULATED OTHER COMPREHENSIVE LOSS The table below presents our accumulated other comprehensive loss by component: December 31, 2023 2022 Adjustments for defined benefit plans $ (180) $ (178) Unrealized gains on investments (1) (3) Accumulated other comprehensive loss $ (181) $ (181) The following table presents the income tax expense (benefit) from each component of our other comprehensive income: December 31, 2023 2022 Adjustments for defined benefit plans $ — $ 18 Foreign currency translation adjustments and other — (1) Net income tax expense related to items of other comprehensive income $ — $ 17

NET OPERATING REVENUES

NET OPERATING REVENUES	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
NET OPERATING REVENUES	CONTRACT BALANCES Hospital Operations Segment Our Hospital Operations segment’s contract assets and liabilities primarily derive from: (1) patients receiving ongoing inpatient care from one of our facilities at the end of the reporting period; (2) timing differences between our performance of revenue cycle management and other contractually-based services and the invoicing or receipt of payment for these services; and, with respect to the year ended December 31, 2021 as discussed below, (3) advance payments from the MAPP following its expansion under the COVID Acts. Our Hospital Operations segment’s contract assets were included in other current assets, and its contract liabilities are included in other current liabilities or other long‑term liabilities, depending upon when we expect to recognize the underlying revenue, in the accompanying Consolidated Balance Sheets at December 31, 2023 and 2022. The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows: Receivables Contract Assets – Contract Liabilities – Contract Liabilities – December 31, 2022 $ 37 $ 200 $ 110 $ 13 December 31, 2023 21 208 59 12 Increase (decrease) $ (16) $ 8 $ (51) $ (1) December 31, 2021 $ 28 $ 199 $ 955 $ 15 December 31, 2022 37 200 110 13 Increase (decrease) $ 9 $ 1 $ (845) $ (2) At December 31, 2021, the current portion of our Hospital Operations segment’s contract liabilities included $876 million of MAPP advances. All remaining MAPP advances received by our Hospital Operations segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. In the years ended December 31, 2023 and 2022, we recognized revenue totaling $71 million and $56 million, respectively, from our revenue cycle management services that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those contract clients who were billed in advance, changes in estimates related to metric‑based services and up‑front integration services that are recognized over the service period. Contract Costs— We recognized amortization expense related to deferred contract setup costs of $5 million in the year ended December 31, 2023, and $4 million in each of the years ended December 31, 2022 and 2021. At December 31, 2023 and 2022, the unamortized customer contract costs were $22 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets. Ambulatory Care Segment All remaining MAPP advances received by our Ambulatory Care segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows: Contract Liabilities – Current Advances from Medicare December 31, 2021 $ 4 December 31, 2022 — Decrease $ (4) Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact and other uninsured discount and charity programs. Net operating revenues for our Hospital Operations segment also includes revenues from providing revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. The table below presents our sources of net operating revenues: Years Ended December 31, 2023 2022 2021 Hospital Operations: Net patient service revenues from hospitals and related outpatient facilities: Medicare $ 2,383 $ 2,369 $ 2,615 Medicaid 1,233 1,069 1,254 Managed care 10,248 9,607 9,985 Uninsured 96 141 199 Indemnity and other 590 661 706 Total 14,550 13,847 14,759 Other revenues (1) 2,133 2,079 2,008 Total Hospital Operations 16,683 15,926 16,767 Ambulatory Care 3,865 3,248 2,718 Net operating revenues $ 20,548 $ 19,174 $ 19,485 (1) Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure. Revenues related to the Texas Comprehensive Hospital Increase Reimbursement Program (“CHIRP”) are presented in managed care net patient service revenues in the table above. Amounts we were assessed to support CHIRP following its approval in 2022 were presented in Medicaid revenues during that period, but have been reclassified to managed care revenues to conform to the current‑year presentation in the same payer group as the revenues to more clearly reflect the results of our participation in this program. Assessments to support CHIRP totaled $126 million and $123 million during the years ended December 31, 2023 and 2022, respectively. Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2023, 2022 and 2021 by $24 million, $10 million and $26 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Consolidated Balance Sheets (see Note 3). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid. The following table presents the composition of net operating revenues for our Ambulatory Care segment: Years Ended December 31, 2023 2022 2021 Net patient service revenues $ 3,713 $ 3,115 $ 2,604 Management fees 123 110 86 Revenue from other sources 29 23 28 Net operating revenues $ 3,865 $ 3,248 $ 2,718 Performance Obligations The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032. Years Ending December 31, Later Years Total 2024 2025 2026 2027 2028 Performance obligations $ 6,026 $ 685 $ 684 $ 683 $ 683 $ 683 $ 2,608

INSURANCE

INSURANCE	12 Months Ended
	Dec. 31, 2023
Property and Professional and General Liablity Insurance [Abstract]
INSURANCE	INSURANCE Property Insurance We have property, business interruption and related insurance coverage to mitigate the financial impact of catastrophic events or perils that is subject to deductible provisions based on the terms of the policies. These policies are issued on an occurrence basis. For the policy period of April 1, 2023 through March 31, 2024, we have coverage totaling $850 million per occurrence, after deductibles and exclusions, with annual aggregate sub‑limits of $100 million for floods, $200 million for earthquakes in California, $200 million for all other earthquakes and a per‑occurrence sub‑limit of $200 million per named windstorm with no annual aggregate. With respect to fires and other perils, excluding floods, earthquakes and named windstorms, the total $850 million limit of coverage per occurrence applies. Deductibles are 5% of insured values for earthquakes in California and named windstorms, and 2% of insured values for earthquakes in the New Madrid fault zone, each with a maximum deductible per claim of $25 million. All other covered losses are subject to a minimum deductible of $5 million per occurrence. We also purchase cyber liability insurance from third parties. In April 2022, we experienced a cybersecurity incident that temporarily disrupted a subset of our hospital operations and involved the exfiltration of certain confidential company and patient information. We received $41 million and $14 million of insurance recoveries related to this cybersecurity incident during the years ended December 31, 2023 and 2022, respectively; of these amounts, we recorded $34 million and $6 million as net operating revenues during 2023 and 2022, respectively. Professional and General Liability Reserves We are self‑insured for the majority of our professional and general liability claims, and we purchase insurance from third‑parties to cover catastrophic claims. At December 31, 2023 and 2022, the aggregate current and long‑term professional and general liability reserves in the accompanying Consolidated Balance Sheets was $1.046 billion and $1.045 billion, respectively. These accruals include the reserves recorded by our captive insurance subsidiaries and our self‑insured retention reserves recorded based on modeled estimates for the portion of our professional and general liability risks, including incurred but not reported claims, for which we do not have insurance coverage. Commercial insurance we purchase is subject to per‑claim and policy period aggregate limits. If the policy period aggregate limit of any of our policies is exhausted, in whole or in part, it could deplete or reduce the limits available to pay other material claims applicable to that policy period. Malpractice expense of $369 million, $276 million and $355 million was included in other operating expenses, net, in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively, of which $116 million, $74 million and $131 million, respectively, related to adverse claims development for prior years.

CLAIMS AND LAWSUITS

CLAIMS AND LAWSUITS	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
CLAIMS AND LAWSUITS	CLAIMS AND LAWSUITS We operate in a highly regulated and litigious industry. Healthcare companies are subject to numerous investigations by various governmental agencies. Further, private parties have the right to bring qui tam or “whistleblower” lawsuits against companies that allegedly submit false claims for payments to, or improperly retain overpayments from, the government and, in some states, private payers. We and our subsidiaries have received inquiries in recent years from government agencies, and we may receive similar inquiries in future periods. We are also subject to class action lawsuits, employment‑related claims and other legal actions in the ordinary course of business, including potential claims related to, among other things, the care and treatment provided at our hospitals and outpatient facilities, the application of various federal and state labor and privacy laws, tax audits and other matters. Some of these actions may involve large demands, as well as substantial defense costs. We cannot predict the outcome of current or future legal actions against us or the effect that judgments or settlements in such matters may have on us; however, we believe that the ultimate resolution of our existing ordinary‑course claims and lawsuits will not have a material effect on our business or financial condition. New claims or inquiries may be initiated against us from time to time. These matters could (1) require us to pay substantial damages or amounts in judgments or settlements, which, individually or in the aggregate, could exceed amounts, if any, that may be recovered under our insurance policies where coverage applies and is available, (2) cause us to incur substantial expenses, (3) require significant time and attention from our management, and (4) cause us to close or sell hospitals or otherwise modify the way we conduct business. We record accruals for estimated losses relating to claims and lawsuits when available information indicates that a loss is probable and we can reasonably estimate the amount of the loss or a range of loss. Significant judgment is required in both the determination of the probability of a loss and the determination as to whether a loss is reasonably estimable. These determinations are updated at least quarterly and are adjusted to reflect the effects of negotiations, settlements, rulings, advice of legal counsel and technical experts, and other information and events pertaining to a particular matter, but are subject to significant uncertainty regarding numerous factors that could affect the ultimate loss levels. If a loss on a material matter is reasonably possible and estimable, we disclose an estimate of the loss or a range of loss. We do not disclose an estimate when we have concluded that a loss is either not reasonably possible or a loss, or a range of loss, is not reasonably estimable, based on available information. Given the inherent uncertainties associated with material legal matters, especially those involving governmental agencies, and the indeterminate damages sought in some cases, we are unable to predict the ultimate liability we may incur from such matters, and an adverse outcome in one or more of these matters could be material to our results of operations or cash flows for any particular reporting period. The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs: Balances at Litigation and Cash Other Balances at Year Ended December 31, 2023 $ 51 $ 47 $ (59) $ 1 $ 40 Year Ended December 31, 2022 $ 78 $ 70 $ (100) $ 3 $ 51 Year Ended December 31, 2021 $ 26 $ 116 $ (59) $ (5) $ 78

REDEEMABLE NONCONTROLLING INTER

REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES	12 Months Ended
	Dec. 31, 2023
Noncontrolling Interest [Abstract]
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES	REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES We had a put/call agreement (the “Baylor Put/Call Agreement”) with Baylor that contained put and call options with respect to the 5% voting ownership interest Baylor previously held in USPI. Based on the nature of the Baylor Put/Call Agreement, Baylor’s minority interest in USPI was classified as a redeemable noncontrolling interest in our consolidated balance sheet. In June 2022, we entered into an agreement to purchase Baylor’s entire 5% ownership interest for $406 million. We paid $11 million upon execution of the share purchase agreement and are obligated to make a total of 35 additional non-interest-bearing monthly payments of approximately $11 million, which payments commenced in August 2022. In June 2022, we recorded the present value of the purchase price as a liability on our balance sheet, with an offset to redeemable noncontrolling interest of $365 million for the carrying amount of the shares and $23 million to additional paid‑in capital for the difference between the carrying value and present value of the purchase price for the shares. At both December 31, 2023 and 2022, we had a liability of $135 million recorded in other current liabilities in the accompanying Consolidated Balance Sheets for the purchase of these shares. The long-term portion of our obligation related to the share repurchase was $63 million and $190 million at December 31, 2023 and 2022, respectively, which amounts were included in other long-term liabilities in the accompanying Consolidated Balance Sheets. The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries: December 31, 2023 2022 Balances at beginning of period $ 2,149 $ 2,203 Net income 366 348 Distributions paid to noncontrolling interests (305) (331) Accretion of redeemable noncontrolling interests — 104 Purchases and sales of businesses and noncontrolling interests, net 181 (175) Balances at end of period $ 2,391 $ 2,149 The following tables show the composition by segment of our redeemable noncontrolling interests balances, as well as our net income available to redeemable noncontrolling interests: December 31, 2023 2022 Hospital Operations $ 860 $ 792 Ambulatory Care 1,531 1,357 Redeemable noncontrolling interests $ 2,391 $ 2,149 Years Ended December 31, 2023 2022 2021 Hospital Operations $ 84 $ 100 $ 93 Ambulatory Care 282 248 243 Net income available to redeemable noncontrolling interests $ 366 $ 348 $ 336

INCOME TAXES

INCOME TAXES	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The provision for income taxes for continuing operations for the years ended December 31, 2023, 2022 and 2021 consisted of the following: Years Ended December 31, 2023 2022 2021 Current tax expense: Federal $ 208 $ 78 $ 50 State 46 57 111 254 135 161 Deferred tax expense (benefit): Federal 55 174 267 State (3) 35 (17) 52 209 250 $ 306 $ 344 $ 411 A reconciliation between the amount of reported income tax expense and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal tax rate is presented below. Foreign pre-tax loss was $3 million, $8 million and $5 million for the years ended December 31, 2023, 2022 and 2021, respectively. Years Ended December 31, 2023 2022 2021 Tax expense at statutory federal rate of 21% $ 340 $ 282 $ 396 State income taxes, net of federal income tax benefit 70 64 77 Tax benefit attributable to noncontrolling interests (147) (122) (114) Nondeductible goodwill — 1 35 Nondeductible executive compensation 6 10 8 Impact of change in state filing method, net of change in unrecognized tax benefit (20) — — Nondeductible litigation costs — — 1 Stock-based compensation tax benefit (2) (6) (5) Changes in valuation allowance 71 120 2 Prior-year provision to return adjustments and other changes in deferred taxes (9) (12) 8 Other items (3) 7 3 Income tax expense $ 306 $ 344 $ 411 A change in the business interest expense disallowance rules took effect in 2022, resulting in a larger amount of interest disallowance compared to prior years. Deferred income taxes reflect the tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance: December 31, 2023 December 31, 2022 Assets Liabilities Assets Liabilities Depreciation and fixed-asset differences $ — $ 430 $ — $ 436 Reserves related to discontinued operations and restructuring charges 6 — 5 — Receivables (doubtful accounts and adjustments) 222 — 246 — Medicare advance payments — — — — Accruals for retained insurance risks 232 — 227 — Intangible assets — 429 — 416 Other long-term liabilities 32 — 27 — Benefit plans 233 — 207 — Other accrued liabilities 20 — 30 — Investments and other assets — 119 — 112 Interest expense limitation 206 — 133 — Net operating loss carryforwards 71 — 74 — Stock-based compensation 13 — 13 — Right-of-use lease assets and obligations 129 111 192 173 Other items 4 80 11 49 1,168 1,169 1,165 1,186 Valuation allowance (248) — (177) — $ 920 $ 1,169 $ 988 $ 1,186 Below is a reconciliation of the deferred tax assets and liabilities and the corresponding amounts reported in the accompanying Consolidated Balance Sheets: December 31, 2023 2022 Deferred income tax assets $ 77 $ 19 Deferred tax liabilities (326) (217) Net deferred tax liability $ (249) $ (198) During the year ended December 31, 2023, the valuation allowance increased by $71 million, including an increase of $73 million due to limitations on the tax deductibility of interest expense, and a decrease of $2 million due to changes in the expected realizability of deferred tax assets. The balance in the valuation allowance as of December 31, 2023 was $248 million. During the year ended December 31, 2022, the valuation allowance increased by $120 million, including an increase of $123 million due to limitations on the tax deductibility of interest expense, a decrease of $1 million due to the expiration or worthlessness of unutilized net operating loss carryovers, and a decrease of $2 million due to changes in the expected realizability of deferred tax assets. The balance in the valuation allowance as of December 31, 2022 was $177 million. During the year ended December 31, 2021, the valuation allowance increased by $2 million, including an increase of $2 million due to limitations on the tax deductibility of interest expense, a decrease of $2 million due to the expiration or worthlessness of unutilized state net operating loss carryovers, and an increase of $2 million due to changes in the expected realizability of deferred tax assets. The remaining balance in the valuation allowance at December 31, 2021 was $57 million. We account for uncertain tax positions in accordance with FASB ASC 740-10-25, which prescribes a comprehensive model for the financial statement recognition, measurement, presentation and disclosure of uncertain tax positions taken or expected to be taken in income tax returns. The following table summarizes the total changes in unrecognized tax benefits in continuing operations during the years ended December 31, 2023, 2022 and 2021. There were no such changes in discontinued operations. The additions and reductions for tax positions include the impact of items for which the ultimate deductibility is highly certain, but for which there is uncertainty about the timing of such deductions. Such amounts include unrecognized tax benefits that have impacted deferred tax assets and liabilities at December 31, 2023, 2022 and 2021. Continuing Balance At December 31, 2020 $ 31 Reductions due to a lapse of statute of limitations 3 Balance At December 31, 2021 $ 34 Reductions due to a lapse of statute of limitations — Balance At December 31, 2022 $ 34 Increases due to tax positions taken in prior periods 31 Reductions due to a lapse of statute of limitations (1) Balance At December 31, 2023 $ 64 The total amount of unrecognized tax benefits as of December 31, 2023 was $64 million, of which $63 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. Income tax expense in the year ended December 31, 2023 included expense of $24 million in continuing operations attributable an increase in our estimated liabilities for uncertain tax positions, net of related deferred tax effects. The total amount of unrecognized tax benefits as of December 31, 2022 was $34 million, of which $32 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. In the year ended December 31, 2022, there was no change in our estimated liabilities for uncertain tax positions, net of related deferred tax effects. The total amount of unrecognized tax benefits as of December 31, 2021 was $34 million, of which $32 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. Income tax expense in the year ended December 31, 2021 included expense of $3 million in continuing operations attributable to an increase in our estimated liabilities for uncertain tax positions, net of related deferred tax effects. Our practice is to recognize interest and penalties related to income tax matters in income tax expense in our consolidated statements of operations. Approximately $2 million of interest and penalties related to accrued liabilities for uncertain tax positions are included in the accompanying Consolidated Statement of Operations for the year ended December 31, 2023. Total accrued interest or penalties on unrecognized tax benefits as of December 31, 2023 was $2 million. The IRS has completed audits of our tax returns for all tax years ended on or before December 31, 2007. All disputed issues with respect to these audits have been resolved and all related tax assessments (including interest) have been paid. Our tax returns for years ended after December 31, 2007 and USPI’s tax returns for years ended after December 31, 2020 remain subject to audit by the IRS. As of December 31, 2023, no significant changes in unrecognized federal and state tax benefits are expected in the next 12 months as a result of the settlement of audits, the filing of amended tax returns or the expiration of statutes of limitations. At December 31, 2023, our carryforwards available to offset future taxable income consisted of (1) federal net operating loss (“NOL”) carryforwards of approximately $41 million pre‑tax, $39 million of which expires in 2026 to 2037 and $2 million of which has no expiration date, (2) charitable contribution carryforwards of approximately $52 million expiring in 2025 through 2027 and (3) state NOL carryforwards of approximately $3.339 billion expiring in 2024 through 2043 for which the associated deferred tax benefit, net of valuation allowance and federal tax impact, is approximately $35 million. Our ability to utilize NOL carryforwards to reduce future taxable income may be limited under Section 382 of the Internal Revenue Code if certain ownership changes in our company occur during a rolling three‑year period. These ownership changes include purchases of common stock under share repurchase programs, the offering of stock by us, the purchase or sale of our stock by 5% shareholders, as defined in the Treasury regulations, or the issuance or exercise of rights to acquire our stock. If such ownership changes by 5% shareholders result in aggregate increases that exceed 50 percentage points during the three‑year period, then Section 382 imposes an annual limitation on the amount of our taxable income that may be offset by the NOL carryforwards or tax credit carryforwards at the time of ownership change.

EARNINGS PER COMMON SHARE

EARNINGS PER COMMON SHARE	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
EARNINGS PER COMMON SHARE	EARNINGS PER COMMON SHARE The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings per common share calculations for our continuing operations. Net income available to our common shareholders is expressed in millions and weighted average shares are expressed in thousands. Net Income Available to Common Shareholders (Numerator) Weighted Per-Share Year Ended December 31, 2023 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 611 101,639 $ 6.01 Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock (13) 3,161 (0.30) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 598 104,800 $ 5.71 Year Ended December 31, 2022 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 410 106,929 $ 3.83 Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock 8 3,587 (0.05) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 418 110,516 $ 3.78 Year Ended December 31, 2021 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 915 106,833 $ 8.56 Effect of dilutive stock options, restricted stock units and deferred compensation units — 1,738 (0.13) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 915 108,571 $ 8.43 During the years ended December 31, 2023 and 2022, our convertible instruments consisted of an agreement related to the ownership interest in a Hospital Operations segment joint venture and RSUs issued under the USPI Management Equity Plan; however, during the first six months of 2022, our convertible instruments also included the Baylor Put/Call Agreement. Additional information about the USPI Management Equity Plan and the Baylor Put/Call Agreement is included in Notes 10 and 18, respectively.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS We are required to provide additional disclosures about fair value measurements as part of our financial statements for each major category of assets and liabilities measured at fair value. In general, fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities, which generally are not applicable to non‑financial assets and liabilities. Fair values determined by Level 2 inputs utilize data points that are observable, such as definitive sales agreements, appraisals or established market values of comparable assets. Fair values determined by Level 3 inputs utilize unobservable data points for the asset or liability and include situations where there is little, if any, market activity for the asset or liability, such as internal estimates of future cash flows. Non-Recurring Fair Value Measurements Our non‑financial assets and liabilities not permitted or required to be measured at fair value on a recurring basis typically relate to long‑lived assets held and used, long‑lived assets held for sale and goodwill. The following table presents this information about assets measured at fair value at December 31, 2023 and 2022 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values: Total Quoted Prices Significant Other Significant December 31, 2023 Long-lived assets held for sale $ 775 $ — $ 775 $ — December 31, 2022 Long-lived assets held and used $ 167 $ — $ 167 $ — As discussed in Note 6, we recognized an impairment charge of $82 million to write down certain long‑lived assets located in one of our markets to their estimated fair value during the year ended December 31, 2022. Financial Instruments The fair value of our long‑term debt (except for borrowings under the Credit Agreement) is based on quoted market prices (Level 1). The inputs used to establish the fair value of the borrowings outstanding under the Credit Agreement are considered to be Level 2 inputs. At December 31, 2023 and 2022, the estimated fair value of our long‑term debt was approximately 96.9% and 92.8%, respectively, of the carrying value of the debt.

ACQUISITIONS

ACQUISITIONS	12 Months Ended
	Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]
ACQUISITIONS	ACQUISITIONS In December 2023, we purchased 55% of the ownership interest held by NextCare, Inc. and certain of its affiliates (“NextCare”) in NextCare Arizona I JV, LLC (“NextCare JV I”), a joint venture established to own and operate 41 UCCs and a telehealth center in Arizona. We paid $75 million from cash on hand on the acquisition date and retained an additional $10 million in escrow pending NextCare’s compliance with certain conditions. We recognized goodwill of $133 million from our acquisition of NextCare JV I. This transaction allowed us to expand our existing network in Arizona with UCCs which are already established and operational. NextCare JV I is included in our Hospital Operations segment. During the year ended December 31, 2023, we acquired controlling ownership interests in 20 ambulatory surgery centers through a series of transactions. In addition, we acquired controlling ownership interests in 11 previously unconsolidated ambulatory surgery centers during 2023. We paid an aggregate of $149 million to acquire controlling ownership interests in all of the aforementioned facilities. In July 2022, we acquired controlling ownership interests in 19 fully operational ambulatory surgery centers and three centers then in development from United Urology Group. We paid $104 million, net of cash acquired, for our ownership interests in these facilities and recognized goodwill of $316 million. The aggregate acquisition date fair value of the non‑controlling interests in the facilities we acquired was $223 million. The acquisition of these facilities provided us with access to new markets and further diversified our ambulatory care services portfolio. We acquired controlling interests in an additional 11 ambulatory surgery centers through a series of transactions during the year ended December 31, 2022. We paid an aggregate purchase price of $65 million, net of cash acquired, for these facilities. During 2022, we also acquired controlling interests in 23 ambulatory surgery centers in which we previously owned a noncontrolling interest for an aggregate purchase price of $65 million. In December 2021, subsidiaries of USPI acquired ownership interests in 86 ambulatory surgery centers and related ambulatory support services (collectively, the “SCD Centers”) from Surgical Center Development #3, LLC and Surgical Center Development #4, LLC (together, “SCD”). Of these, we acquired controlling interests in 15 ambulatory surgery centers, noncontrolling interests in 57 centers and interests in 14 centers still in the development stage. The newly acquired facilities augmented our Ambulatory Care segment’s existing musculoskeletal service line and expanded the number of markets it serves. We made a cash payment of $1.125 billion, net of cash acquired, to acquire these facilities. In addition to the SCD Centers, we paid an aggregate purchase price of $74 million to acquire controlling interests in 11 outpatient businesses and various physician practices during the year ended December 31, 2021. During 2021, we also acquired controlling interests in three surgical hospitals and two ambulatory surgery centers in which we previously owned a noncontrolling interest for $21 million. We are required to allocate the purchase prices of acquired businesses to assets acquired or liabilities assumed and, if applicable, noncontrolling interests based on their fair values. The excess of the purchase price allocated over those fair values is recorded as goodwill. The purchase price allocations for certain acquisitions completed in 2023 are preliminary. We are in process of assessing working capital balances as well as obtaining and evaluating valuations of the acquired property and equipment, management contracts and other intangible assets, and noncontrolling interests. Therefore, those purchase price allocations, including goodwill, recorded in the accompanying consolidated financial statements are subject to adjustment once the assessments and valuation work are completed and evaluated. Such adjustments will be recorded as soon as practical and within the measurement period as defined by the accounting literature. During the year ended December 31, 2023, we adjusted the initial purchase allocation of certain acquisitions completed in 2022 based on the results of completed valuations. These adjustments resulted in a net decrease in our Ambulatory Care segment’s goodwill of $18 million. Preliminary or final purchase price allocations for all the acquisitions made during the years ended December 31, 2023, 2022 and 2021 are as follows: Years Ended December 31, 2023 2022 2021 Current assets $ 34 $ 38 $ 59 Property and equipment 28 54 88 Other intangible assets 5 2 8 Goodwill 644 860 664 Other long-term assets 32 99 796 Previously held equity method investments (99) (207) (43) Current liabilities (36) (41) (25) Long-term liabilities (37) (118) (70) Redeemable noncontrolling interests in equity of consolidated subsidiaries (229) (180) (139) Noncontrolling interests (102) (273) (95) Cash paid, net of cash acquired (224) (234) (1,220) Gains on consolidations $ 16 $ — $ 23 With the exception of NextCare JV I, which is included in our Hospital Operations segment, all of the facilities described above are included in our Ambulatory Care segment. The majority of the goodwill generated from our 2023 and 2021 acquisitions will be deductible for income tax purposes; however, the majority of the goodwill generated from our 2022 transactions will not be. The goodwill generated from these transactions can be attributed to the benefits that we expect to realize from operating efficiencies and growth strategies. Approximately $15 million, $14 million and $20 million in transaction costs related to prospective and closed acquisitions were expensed during the years ended December 31, 2023, 2022 and 2021, respectively, and are included in impairment and restructuring charges, and acquisition‑related costs in the accompanying Consolidated Statements of Operations. During the year ended December 31, 2023 and 2021, we recognized gains totaling $16 million and $23 million, respectively, associated with stepping up our ownership interests in previously held equity investments, which we began consolidating after we acquired controlling interests. No such gain or loss was recognized in the year ended December 31, 2022.

SEGMENT INFORMATION

SEGMENT INFORMATION	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
SEGMENT INFORMATION	SEGMENT INFORMATION At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). See Note 1 for additional discussion of this change. Our Hospital Operations segment is comprised of our acute care and specialty hospitals, physician practices and outpatient facilities. At December 31, 2023, our subsidiaries operated 61 hospitals, serving primarily urban and suburban communities in nine states, as well as 164 outpatient facilities, primarily imaging centers, UCCs, ancillary emergency facilities and micro-hospitals. The following transactions changed the number of facilities in our Hospital Operations segment during the years ended December 31, 2023, 2022 and 2021: • On April 1, 2021, we transferred 24 imaging centers from our Ambulatory Care segment to our Hospital Operations segment; the total assets associated with the imaging centers transferred to our Hospital Operations segment constituted less than 1% of our consolidated total assets at March 31, 2021; • Also in April 2021, we completed the sale of the majority of the UCCs then held by our Hospital Operations segment to an unaffiliated urgent care provider; • We completed the sale of the Miami Hospitals in August 2021; • In September 2022, we opened Piedmont Medical Center Fort Mill, a new hospital located in South Carolina; and • In December 2023, we acquired a controlling interest in NextCare JV I and a minority interest in NextCare Arizona II JV, LLC. Through these transactions, we acquired a controlling interest in 41 fully operational UCCs and a telehealth center and a noncontrolling interest in an additional 15 fully operational UCCs, all located in Arizona. Our Hospital Operations segment also provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. Our Ambulatory Care segment is comprised of the operations of USPI. At December 31, 2023, USPI had ownership interests in 461 ambulatory surgery centers (322 consolidated) and 24 surgical hospitals (eight consolidated) in 35 states. We completed the divestiture of 40 UCCs held by our Ambulatory Care segment on April 1, 2021. Effective June 30, 2022, we purchased all of the shares in USPI that Baylor held on that date for $406 million, which increased our ownership interest in USPI’s voting shares from 95% to 100% (see Note 18 for additional information about this transaction). The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Consolidated Balance Sheets and Consolidated Statements of Operations, as applicable: December 31, 2023 2022 2021 Assets: Hospital Operations $ 17,268 $ 16,599 $ 18,106 Ambulatory Care 11,044 10,557 9,473 Total $ 28,312 $ 27,156 $ 27,579 Years Ended December 31, 2023 2022 2021 Capital expenditures: Hospital Operations $ 671 $ 687 $ 592 Ambulatory Care 80 75 66 Total $ 751 $ 762 $ 658 Net operating revenues: Hospital Operations $ 16,683 $ 15,926 $ 16,767 Ambulatory Care 3,865 3,248 2,718 Total $ 20,548 $ 19,174 $ 19,485 Equity in earnings of unconsolidated affiliates: Hospital Operations $ 10 $ 10 $ 25 Ambulatory Care 218 206 193 Total $ 228 $ 216 $ 218 Adjusted EBITDA: Hospital Operations $ 1,997 $ 2,142 $ 2,286 Ambulatory Care 1,544 1,327 1,197 Total $ 3,541 $ 3,469 $ 3,483 Depreciation and amortization: Hospital Operations $ 750 $ 729 $ 760 Ambulatory Care 120 112 95 Total $ 870 $ 841 $ 855 Years Ended December 31, 2023 2022 2021 Adjusted EBITDA $ 3,541 $ 3,469 $ 3,483 Loss from divested and closed businesses — — (1) Depreciation and amortization (870) (841) (855) Impairment and restructuring charges, and acquisition-related costs (137) (226) (85) Litigation and investigation costs (47) (70) (116) Interest expense (901) (890) (923) Loss from early extinguishment of debt (11) (109) (74) Other non-operating income, net 19 10 14 Gains on sales, consolidation and deconsolidation of facilities 23 1 445 Income from continuing operations, before income taxes $ 1,617 $ 1,344 $ 1,888

RECENT ACCOUNTING STANDARDS

RECENT ACCOUNTING STANDARDS	12 Months Ended
	Dec. 31, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]
RECENT ACCOUNTING STANDARDS	RECENT ACCOUNTING STANDARDS Recently Issued Accounting Standards In November 2023, the FASB issued ASU 2023-07, “Improvements to Reportable Segment Disclosures” (“ASU 2023-07”). The standard expands reportable segment disclosure requirements by requiring disclosures of significant reportable segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of a segment's profit or loss. The ASU also requires disclosure of the title and position of the individual identified as the CODM and an explanation of how the CODM uses the reported measures of a segment's profit or loss in assessing segment performance and deciding how to allocate resources. Additionally, ASU 2023-07 requires all segment profit or loss and assets disclosures to be provided on an annual and interim basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning one year later. Early adoption is permitted and the amendments must be applied retrospectively to all prior periods presented. The adoption of this guidance will not affect our consolidated results of operations, financial position or cash flows and we are currently evaluating the effect the guidance will have on our disclosures. In August 2023, the FASB issued ASU 2023-05, “Business Combinations – Joint Venture Formations (Subtopic 805-60): Recognition and Initial Measurement” (“ASU 2023-05”), which clarifies the business combination accounting for joint venture formations. The amendments in the ASU seek to reduce diversity in practice that has resulted from a lack of authoritative guidance regarding the accounting for the formation of joint ventures in separate financial statements. The amendments also seek to clarify the initial measurement of joint venture net assets, including businesses contributed to a joint venture. The guidance is applicable to all entities involved in the formation of a joint venture. ASU 2023-05 is effective prospectively for all joint venture formations with a formation date on or after January 1, 2025. Early adoption and retrospective application of the amendments are permitted. We do not expect adoption of the new guidance to have a material impact on our consolidated financial statements and disclosures. The FASB issued ASU 2022‑03, “Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions” (“ASU 2022‑03”) in June 2022. Through ASU 2022‑03 the FASB clarified that an entity should measure the fair value of an equity security subject to contractual sale restriction the same way it measures an identical equity security that is not subject to such a restriction and enhanced the disclosure requirements related to these instruments. The ASU is effective for public entities for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years, and early adoption is permitted. For non‑investment companies, ASU 2022‑03 will be applied prospectively with adjustments resulting from the initial adoption recognized in earnings and disclosed. We do not expect adoption of ASU 2022‑03 to have a material impact on our consolidated financial statements and disclosures. Recently Adopted Accounting Standards As further discussed in Note 1, we adopted ASU 2020-06 effective January 1, 2022. We applied the modified retrospective transition approach as of the period of adoption.

SUBSEQUENT EVENT

SUBSEQUENT EVENT	12 Months Ended
	Dec. 31, 2023
Subsequent Events [Abstract]
SUBSEQUENT EVENT	SUBSEQUENT EVENT In January 2024, we entered into a definitive agreement for the sale of four hospitals and related operations in Orange County and Los Angeles County, California, all of which are in our Hospital Operations segment. We anticipate the transaction will close in early 2024, subject to customary regulatory approvals, clearances and closing conditions.

SCHEDULE II-VALUATION AND QUALI

SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS	12 Months Ended
	Dec. 31, 2023
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS	SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS (In Millions) Balance at Costs and Expenses (1) Deductions Other Balance at Valuation allowance for deferred tax assets: Year ended December 31, 2023 $ 177 $ 71 $ — $ — $ 248 Year ended December 31, 2022 $ 57 $ 120 $ — $ — $ 177 Year ended December 31, 2021 $ 55 $ 2 $ — $ — $ 57 (1) Includes amounts recorded in discontinued operations.

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

SIGNIFICANT ACCOUNTING POLICI_2

SIGNIFICANT ACCOUNTING POLICIES (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Our Consolidated Financial Statements include the accounts of Tenet and its wholly owned and majority‑owned subsidiaries. We eliminate intercompany accounts and transactions in consolidation, and we include the results of operations of businesses that are newly acquired in purchase transactions from their dates of acquisition. We account for significant investments in other affiliated companies using the equity method. We also utilize the equity method when we have the ability to exercise significant influence over the affiliated company, despite not holding a significant percentage of its ownership interest. Unless otherwise indicated, all financial and statistical data included in these notes to our Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts) and share amounts expressed in thousands.
Changes to prior-year presentation	Changes to prior-year presentation— At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). This change was made to reflect recent updates to the organizational and management structure of our Conifer and Hospital Operations and other segments. All prior‑period data presented in this report has been adjusted to conform to our new reporting segment structure. As of December 31, 2023, our business was organized into two reporting segments: • our Hospital Operations segment, which includes (1) our acute care and specialty hospitals, physician practices, imaging centers, UCCs, ancillary emergency facilities and micro‑hospitals, and (2) the revenue cycle management and value‑based care services we provide to hospitals, health systems, physician practices, employers and other clients through our Conifer Health Solutions, LLC joint venture; and • our Ambulatory Care segment, which is comprised of the ambulatory surgery center and surgical hospital operations of our subsidiary USPI Holding Company, Inc. In addition, contract liabilities and contract liabilities – long-term are no longer significant enough to present separately. These obligations are now included in other current liabilities and other long-term liabilities, respectively, in the accompanying Consolidated Balance Sheets.
Use of Estimates	The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires us to make estimates and assumptions that affect the amounts reported in our Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Although we believe all adjustments considered necessary for a fair presentation have been included, actual results may vary from those estimates. The financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from the amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public.
Translation of Foreign Currencies	Our GBC, which is located in the Philippines, performs certain administrative functions and other support tasks. The GBC’s accounts are measured in its local currency (the Philippine peso) and then translated into U.S. dollars. All assets and liabilities denominated in foreign currency are translated using the current rate of exchange at the balance sheet date. Results of operations denominated in foreign currency are translated using the average rates prevailing throughout the period of operations. Translation gains or losses resulting from changes in exchange rates are accumulated in shareholders’ equity.
Net Operating Revenues	We recognize net operating revenues in the period in which we satisfy our performance obligations under contracts by transferring services to our customers. Net operating revenues are recognized in the amounts we expect to be entitled to, which are the transaction prices allocated for the distinct services. Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients (“ Compact ”) and other uninsured discount and charity programs. Net Patient Service Revenues We report net patient service revenues at the amounts that reflect the consideration we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third‑party payers (including managed care payers and government programs) and others, and they include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews and investigations. Generally, we bill our patients and third‑party payers several days after the services are performed or shortly after discharge. Revenues are recognized as performance obligations are satisfied. We determine performance obligations based on the nature of the services we provide. We recognize revenues for performance obligations satisfied over time based on actual charges incurred in relation to total expected charges. We believe that this method provides a faithful depiction of the transfer of services over the term of performance obligations based on the inputs needed to satisfy the obligations. Generally, performance obligations satisfied over time relate to patients in our hospitals receiving inpatient acute care services. We measure performance obligations from admission to the point when there are no further services required for the patient, which is generally the time of discharge. We recognize revenues for performance obligations satisfied at a point in time, which generally relate to patients receiving outpatient services, when (1) services are provided, and (2) we do not believe the patient requires additional services. Because our patient service performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in FASB Accounting Standards Codification (“ASC”) 606‑10‑50‑14(a) and, therefore, we are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by contractual adjustments recognized for third‑party payers, discounts provided to uninsured patients in accordance with our Compact , and estimated implicit price concessions related primarily to uninsured patients. We determine our estimates of contractual adjustments and discounts based on contractual agreements, our discount policies and historical experience. We determine our estimate of implicit price concessions based on our historical collection experience using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach. Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and, therefore, are not displayed in our consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop‑loss payments). Because Medicare requires that a hospital’s gross charges be the same for all patients (regardless of payer category), gross charges are what hospitals charge all patients prior to the application of discounts and allowances. Government Programs— The final determination of certain fee‑for‑service (“FFS”) Medicare and Medicaid program payments to our hospitals, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, are retrospectively determined based on our hospitals’ cost reports. The final determination of these payments often takes many years to resolve because of audits by the program representatives, providers’ rights of appeal, and the application of numerous technical reimbursement provisions. We therefore record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we adjust the accrual for estimated cost report settlements based on those cost reports and subsequent activity, and we consider the necessity of recording a valuation allowance based on historical settlement results. The accrual for estimated cost report settlements for periods for which a cost report is yet to be filed is recorded based on estimates of what we expect to report on the filed cost reports, and a corresponding valuation allowance is recorded, if necessary, based on the method previously described. Cost reports must generally be filed within five months after the end of the annual cost report reporting period. After the cost report is filed, the accrual and corresponding valuation allowance may need to be adjusted. Settlements with third‑party payers for retroactive revenue adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care using the most likely outcome method. These settlements are estimated based on the terms of the payment agreement with the payer, correspondence from the payer and our historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Because the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates we record could change by material amounts. Private Insurance— Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per‑diem rates, discounted FFS rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers, which can take several years before they are completely resolved. The payers are billed for patient services on an individual patient basis. An individual patient’s bill is subject to adjustment on a patient‑by‑patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. We estimate the discounts for contractual allowances at the individual hospital level utilizing billing data on an individual patient basis. At the end of each month, on an individual hospital basis, we estimate our expected reimbursement for patients of managed care plans based on the applicable contract terms. Contractual allowance estimates are periodically reviewed for accuracy by taking into consideration known contract terms, as well as payment history. We believe our estimation and review process enables us to identify instances on a timely basis where such estimates need to be revised. We do not believe there were any adjustments to estimates of patient bills that were material to our revenues during the years ended December 31, 2023, 2022 or 2021. In addition, on a corporate‑wide basis, we do not record any general provision for adjustments to estimated contractual allowances for managed care plans. Managed care accounts, net of contractual allowances recorded, are further reduced to their net realizable value through implicit price concessions based on historical collection trends for these payers and other factors that affect the estimation process. We know of no claims, disputes or unsettled matters with any payer that would materially affect our revenues for which we have not adequately provided in the accompanying Consolidated Financial Statements. Uninsured Patients— Generally, patients who are covered by third‑party payers are responsible for related co‑pays, co‑insurance and deductibles, which vary in amount. We also provide services to uninsured patients and offer uninsured patients a discount from standard charges. We estimate the transaction price for patients with co‑pays, co‑insurance and deductibles and for those who are uninsured based on historical collection experience and current market conditions. Under our Compact and other uninsured discount programs, the discount offered to certain uninsured patients is recognized as a contractual allowance, which reduces net operating revenues at the time the self‑pay accounts are recorded. The uninsured patient accounts, net of contractual allowances recorded, are further reduced to their net realizable value at the time they are recorded through implicit price concessions based on historical collection trends for self‑pay accounts and other factors that affect the estimation process. Implicit Price Concessions— We record implicit price concessions, primarily related to uninsured patients and patients with co‑pays, co‑insurance and deductibles. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts we expect to collect based on our collection history with similar patients. Although outcomes vary, our policy is to attempt to collect amounts due from patients, including co‑pays, co‑insurance and deductibles due from patients with insurance, at the time of service while complying with all federal and state statutes and regulations, including, but not limited to, the Emergency Medical Treatment and Active Labor Act (“EMTALA”). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, services, including the legally required medical screening examination and stabilization of the patient, are performed without delaying to obtain insurance information. In non‑emergency circumstances or for elective procedures and services, it is our policy to verify insurance prior to a patient being treated; however, there are various exceptions that can occur. Such exceptions can include, for example, instances where (1) we are unable to obtain verification because the patient’s insurance company was unable to be reached or contacted, (2) a determination is made that a patient may be eligible for benefits under various government programs, such as Medicaid or Victims of Crime, and it takes several days or weeks before qualification for such benefits is confirmed or denied, and (3) under physician orders we provide services to patients that require immediate treatment. There are various factors that can impact collection trends, such as: changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients; the volume of patients through our emergency departments; the increased burden of co‑pays, co‑insurance amounts and deductibles to be made by patients with insurance; and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and our estimation process. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenues in the period of the change. We also provide charity care to patients who are financially unable to pay for the healthcare services they receive. Most patients who qualify for charity care are charged a per‑diem amount for services received, subject to a cap. Except for the per‑diem amounts, our policy is not to pursue collection of amounts determined to qualify as charity care; therefore, we do not report these amounts in net operating revenues. Patient advocates from our Eligibility and Enrollment Services program screen patients in the hospital to determine whether those patients meet eligibility requirements for financial assistance programs. They also expedite the process of applying for these government programs. Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. Approximately 88% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days. Revenue Cycle Management and Other Services Our Hospital Operations segment also provides revenue cycle management and other services to health systems, individual hospitals and physician practices. We recognize revenue from our contracts when the underlying performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which we expect to be entitled. At contract inception, we assess the services specified in our contracts with customers and identify a performance obligation for each distinct contracted service. We generally consider the following distinct services as separate performance obligations: • revenue cycle management services; • value‑based care services; • patient communication and engagement services; • consulting services; and • other client‑defined projects. Our contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Long‑term contracts typically provide for the delivery of recurring monthly services over a multi‑year period. The contracts are typically priced such that our monthly fee to our customer represents the value obtained by the customer in the month for those services. Such multi‑year service contracts may have upfront fees related to transition or integration work performed by us to set up the delivery for the ongoing services. Such transition or integration work typically does not result in a separately identifiable obligation; thus, the fees and expenses related to such work are deferred and recognized over the life of the related contractual service period. For contracts in which the amortization period of the asset is one year or less, we have elected to apply the practical expedient provided by FASB ASC 340‑40‑25‑4 and expense these costs as incurred. Revenue for fixed‑priced contracts is typically recognized at the time of billing unless evidence suggests that the revenue is earned or our obligations are fulfilled in a different pattern. Revenue for volume‑based contracts is typically recognized as the services are being performed at the contractually billable rate, which is generally a percentage of collections or a percentage of client net patient revenue. Contract Assets and Liabilities— Our client contract terms, including payment conditions, are diverse. For non‑fixed‑price arrangements, we may invoice clients before we perform the contracted services, with subsequent adjustments (true‑up) to align with actual fees. In contrast, some contracts require payment after we have performed the contracted services (in arrears). Contracts may also feature performance‑based incentives or penalties, along with other variable consideration. Revenue recognition occurs when services are rendered and the client gains control or benefit of the services, regardless of the invoicing schedule, leading to the recognition of a contract asset for unbilled revenue. Unbilled revenue is recognized as receivables in the month the services are performed. Conversely, advance payments from clients result in the recognition of a contract liability for deferred revenue until the revenue recognition requirements are met.
Cash and Cash Equivalents	We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $1.228 billion and $858 million at December 31, 2023 and 2022, respectively. At December 31, 2023 and 2022, our book overdrafts were $187 million and $266 million, respectively, which were classified as accounts payable. At December 31, 2023 and 2022, $100 million and $140 million, respectively, of total cash and cash equivalents in the accompanying Consolidated Balance Sheets were intended for the operations of our insurance‑related subsidiaries. At December 31, 2023, 2022 and 2021, we had $154 million, $196 million and $95 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $141 million, $191 million and $88 million, respectively, were included in accounts payable. In June 2022, we acquired all of Baylor’s 5% voting ownership interest in USPI. We paid $11 million from cash on hand and recognized a liability of $377 million, the present value of the liability on the acquisition date, for the remainder of the purchase price. We recorded reductions in redeemable noncontrolling interest of $365 million for the carrying value of Baylor’s ownership interest and $23 million to additional paid-in capital for the difference between the carrying value and present value of the purchase price for the shares on the acquisition date. This has been reflected as noncash financing activity in the accompanying Consolidated Statement of Cash Flows for the year ended December 31, 2022. Payments made subsequent to the transaction’s close are reflected as cash activity within the financing section of our consolidated statements of cash flows in the respective period. See Note 18 for additional information about this transaction.
Investments in Debt and Equity Securities	We classify investments in debt securities as either available‑for‑sale, held‑to‑maturity or as part of a trading portfolio. Our policy is to classify investments in debt securities that may be needed for cash requirements as “available‑for‑sale.” At December 31, 2023 and 2022, we had no significant investments in debt securities classified as either held‑to‑maturity or trading. We carry debt securities classified as available‑for‑sale at fair value. We report their unrealized gains and losses, net of taxes, as accumulated other comprehensive income (loss). We periodically evaluate available-for-sale securities in unrealized loss positions for credit impairment, using both qualitative and quantitative criteria. In the event a security is deemed to be impaired as the result of a credit loss, we record a loss in our consolidated statements of operations. We carry equity securities at fair value, and we report their unrealized gains and losses in other non-operating income, net, in our consolidated statements of operations. If the equity security does not have a readily determinable fair value, the carrying value of the security is adjusted only when there is a price change that is observable from a transaction of an identical or similar investment. We include realized gains or losses in our consolidated statements of operations based on the specific identification method.
Investments in Unconsolidated Affiliates	As of December 31, 2023, we controlled 330 of the facilities in our Ambulatory Care segment and, therefore, consolidated their results. We account for many of the facilities in which our Ambulatory Care segment holds ownership interests (155 of 485 at December 31, 2023), as well as additional companies in which our Hospital Operations segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Consolidated Statements of Operations. In the year ended December 31, 2021, equity in earnings of unconsolidated affiliates included $14 million from grant funds recognized by our Ambulatory Care segment’s unconsolidated affiliates. No additional revenue was recognized from grant funds by unconsolidated affiliates during the years ended December 31, 2023 and 2022. Summarized financial information for equity method investees is included in the following table. For investments acquired during the reported periods, amounts below include 100% of the investee’s results beginning on the date of our acquisition of the investment. December 31, 2023 2022 2021 Current assets $ 1,223 $ 1,142 $ 1,176 Noncurrent assets $ 1,355 $ 1,356 $ 1,390 Current liabilities $ (456) $ (479) $ (495) Noncurrent liabilities $ (917) $ (878) $ (855) Noncontrolling interests $ (670) $ (644) $ (659) Years Ended December 31, 2023 2022 2021 Net operating revenues $ 3,510 $ 3,360 $ 3,030 Net income $ 860 $ 805 $ 836 Net income attributable to the investees $ 484 $ 453 $ 499 The equity method investment that contributed the most to our equity in earnings of unconsolidated affiliates during the years ended December 31, 2023, 2022 and 2021 was Texas Health Ventures Group, LLC (“THVG”), which is operated by USPI. THVG represented $104 million, $89 million and $107 million of total equity in earnings of unconsolidated affiliates of $228 million, $216 million and $218 million in the years ended December 31, 2023, 2022 and 2021, respectively.
Property and Equipment	Additions and improvements to property and equipment exceeding established minimum amounts with a useful life greater than one year are capitalized at cost. Expenditures for maintenance and repairs are charged to expense as incurred. We use the straight‑line method of depreciation for buildings, building improvements and equipment. The estimated useful life for buildings and improvements is primarily 15 to 40 years, and for equipment three We evaluate our long‑lived assets for possible impairment annually or whenever events or changes in circumstances indicate that the carrying amount of the asset, or related group of assets, may not be recoverable from estimated future undiscounted cash flows. If the estimated future undiscounted cash flows are less than the carrying value of the assets, we calculate the amount of an impairment charge only if the carrying value of the long‑lived assets exceeds their fair value. The fair value of the asset is estimated based on third‑party appraisals, established market values of comparable assets or internally developed estimates of future net cash flows expected to result from the use and ultimate disposition of the asset. The estimates of these future cash flows are based on assumptions and projections we believe to be reasonable and supportable. Estimates require our subjective judgments and take into account assumptions about revenue and expense growth rates, operating margins and recoverable disposition values, based on industry and operating factors. These assumptions may vary by type of asset and presume stable, improving or, in some cases, declining results, depending on their circumstances. If the presumed level of performance does not occur as expected, impairment may result. We report long‑lived assets to be disposed of at the lower of their carrying amounts or fair values less costs to sell. In such circumstances, our estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows.
Leases	We determine if an arrangement is a lease at inception of the contract. Our right‑of‑use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right‑of‑use assets and lease liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. We use our estimated incremental borrowing rate, which is derived from information available at the lease commencement date, in determining the present value of lease payments. For our Hospital Operations segment, we estimate our incremental borrowing rates for our portfolio of leases using documented rates included in our recent equipment finance leases or, if applicable, recent secured debt issuances that correspond to various lease terms. We also give consideration to information obtained from our bankers, our secured debt fair value and publicly available data for instruments with similar characteristics. For our Ambulatory Care segment, we estimate an incremental borrowing rate for each center by utilizing historical and projected financial data, estimating a hypothetical credit rating using publicly available market data and adjusting the market data to reflect the effects of collateralization. Our operating leases are primarily for real estate, including off‑campus outpatient facilities, medical office buildings, and corporate and other administrative offices, as well as medical and office equipment. Our finance leases are primarily for medical equipment and information technology and telecommunications assets. Our real estate lease agreements typically have initial terms of five Our real estate leases may include one or more options to renew, with renewals that can extend the lease term from five five Certain of our lease agreements for real estate include payments based on actual common area maintenance expenses and others include rental payments adjusted periodically for inflation. These variable lease payments are recognized in other operating expenses, net, but are not included in the right‑of‑use asset or liability balances. Our lease agreements do not contain any material residual value guarantees, restrictions or covenants. We have elected the practical expedient that allows lessees to choose to not separate lease and non‑lease components by class of underlying asset and are applying this expedient to all relevant asset classes. We have also elected the practical expedient package to not reassess at adoption (1) expired or existing contracts for whether they are or contain a lease, (2) the lease classification of any existing leases or (3) initial indirect costs for existing leases.
Goodwill and Other Intangible Assets	Goodwill represents the excess of costs over the fair value of assets of businesses acquired. Goodwill and other intangible assets acquired in purchase business combinations and determined to have indefinite useful lives are not amortized, but instead are subject to impairment tests performed at least annually. Our reporting segments are the reporting units used to perform our goodwill analysis. If we determine the carrying value of goodwill is impaired, or if the carrying value of a business that is to be sold or otherwise disposed of exceeds its fair value, we reduce the carrying value, including any allocated goodwill, to fair value. Estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows and presume stable, improving or, in some cases, declining results at our hospitals, depending on their circumstances. Other intangible assets consist of capitalized software costs, which are amortized on a straight‑line basis over the estimated useful life of the software, which ranges from three
Accruals for General and Professional Liability Risks	We accrue for estimated professional and general liability claims, to the extent not covered by insurance, when they are probable and can be reasonably estimated. We maintain reserves, which are based on modeled estimates for the portion of our professional liability risks, including incurred but not reported claims, to the extent we do not have insurance coverage. Our liability consists of estimates established based upon calculations using several factors, including the number of expected claims, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience and the timing of historical payments. Our liabilities are adjusted for new claims information in the period such information becomes known. Malpractice expense is recorded within other operating expenses in our consolidated statements of operations.
Income Taxes	We account for income taxes using the asset and liability method. This approach requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of temporary differences between the carrying amounts and the tax bases of assets and liabilities. Income tax receivables and liabilities and deferred tax assets and liabilities are recognized based on the amounts that more likely than not will be sustained upon ultimate settlement with taxing authorities. Developing our provision for income taxes and analysis of uncertain tax positions requires significant judgment and knowledge of federal and state income tax laws, regulations and strategies, including the determination of deferred tax assets and liabilities and, if necessary, any valuation allowances that may be required for deferred tax assets. We assess the realization of our deferred tax assets to determine whether an income tax valuation allowance is required. Based on all available evidence, both positive and negative, and the weight of that evidence to the extent such evidence can be objectively verified, we determine whether it is more likely than not that all or a portion of the deferred tax assets will be realized. The main factors that we consider include: • Cumulative profits/losses in recent years, adjusted for certain nonrecurring items; • Income/losses expected in future years; • Unsettled circumstances that, if unfavorably resolved, would adversely affect future operations and profit levels; • The availability, or lack thereof, of taxable income in prior carryback periods that would limit realization of tax benefits; and • The carryforward period associated with the deferred tax assets and liabilities. We consider many factors when evaluating our uncertain tax positions, and such judgments are subject to periodic review. Tax benefits associated with uncertain tax positions are recognized in the period in which one of the following conditions is satisfied: (1) the more likely than not recognition threshold is satisfied; (2) the position is ultimately settled through negotiation or litigation; or (3) the statute of limitations for the taxing authority to examine and challenge the position has expired. Tax benefits associated with an uncertain tax position are derecognized in the period in which the more likely than not recognition threshold is no longer satisfied.
Segment Reporting	Our Hospital Operations segment generated 81%, 83% and 86% of our net operating revenues in the years ended December 31, 2023, 2022 and 2021, respectively. Major decisions, including capital resource allocations, are made at the consolidated level, not at the market or hospital level. The factors for determining the reportable segments include the manner in which management evaluates operating performance combined with the nature of the individual business activities.
Costs Associated With Exit or Disposal Activities	We recognize costs associated with exit (including restructuring) or disposal activities when they are incurred and can be measured at fair value, rather than at the date of a commitment to an exit or disposal plan.
Recent Accounting Standards	We adopted the Financial Accounting Standards Board’s (“FASB”) Accounting Standards Update (“ASU”) 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (“ASU 2020-06”), effective as of January 1, 2022 using the modified retrospective method. Among other amendments, ASU 2020-06 changed the accounting for diluted earnings‑per‑share for convertible instruments and contracts that may be settled in cash or stock. ASU 2020-06 eliminated an entity’s ability to rebut the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. Additionally, ASU 2020-06 requires that the if‑converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments. As a result of our adoption of ASU 2020-06, diluted weighted average shares outstanding increased by approximately 2,364 thousand shares and 2,673 thousand shares for the years ended December 31, 2023 and 2022, respectively, and diluted earnings per share available to Tenet common shareholders decreased by $0.26 and $0.01, respectively, for these same periods. Recently Issued Accounting Standards In November 2023, the FASB issued ASU 2023-07, “Improvements to Reportable Segment Disclosures” (“ASU 2023-07”). The standard expands reportable segment disclosure requirements by requiring disclosures of significant reportable segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of a segment's profit or loss. The ASU also requires disclosure of the title and position of the individual identified as the CODM and an explanation of how the CODM uses the reported measures of a segment's profit or loss in assessing segment performance and deciding how to allocate resources. Additionally, ASU 2023-07 requires all segment profit or loss and assets disclosures to be provided on an annual and interim basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning one year later. Early adoption is permitted and the amendments must be applied retrospectively to all prior periods presented. The adoption of this guidance will not affect our consolidated results of operations, financial position or cash flows and we are currently evaluating the effect the guidance will have on our disclosures. In August 2023, the FASB issued ASU 2023-05, “Business Combinations – Joint Venture Formations (Subtopic 805-60): Recognition and Initial Measurement” (“ASU 2023-05”), which clarifies the business combination accounting for joint venture formations. The amendments in the ASU seek to reduce diversity in practice that has resulted from a lack of authoritative guidance regarding the accounting for the formation of joint ventures in separate financial statements. The amendments also seek to clarify the initial measurement of joint venture net assets, including businesses contributed to a joint venture. The guidance is applicable to all entities involved in the formation of a joint venture. ASU 2023-05 is effective prospectively for all joint venture formations with a formation date on or after January 1, 2025. Early adoption and retrospective application of the amendments are permitted. We do not expect adoption of the new guidance to have a material impact on our consolidated financial statements and disclosures. The FASB issued ASU 2022‑03, “Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions” (“ASU 2022‑03”) in June 2022. Through ASU 2022‑03 the FASB clarified that an entity should measure the fair value of an equity security subject to contractual sale restriction the same way it measures an identical equity security that is not subject to such a restriction and enhanced the disclosure requirements related to these instruments. The ASU is effective for public entities for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years, and early adoption is permitted. For non‑investment companies, ASU 2022‑03 will be applied prospectively with adjustments resulting from the initial adoption recognized in earnings and disclosed. We do not expect adoption of ASU 2022‑03 to have a material impact on our consolidated financial statements and disclosures. Recently Adopted Accounting Standards As further discussed in Note 1, we adopted ASU 2020-06 effective January 1, 2022. We applied the modified retrospective transition approach as of the period of adoption.

SIGNIFICANT ACCOUNTING POLICI_3

SIGNIFICANT ACCOUNTING POLICIES (Tables)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Schedule of Grant Funds Received And Grant Income	As detailed in the table below, we received cash payments from the PRF and state and local grant programs during the years ended December 31, 2023, 2022 and 2021. Grant funds received by our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate are included in cash flows from operating activities in our consolidated statements of cash flows. Grant funds received by unconsolidated affiliates for which we provide cash management services (“Cash‑Managed Affiliates”) are included in cash flows from financing activities. Years Ended December 31, 2023 2022 2021 Grant funds received from COVID-19 relief programs: Included in cash flows from operating activities: Hospital Operations $ 10 $ 193 $ 142 Ambulatory Care — 3 36 $ 10 $ 196 $ 178 Included in cash flows from financing activities: Cash‑Managed Affiliates $ — $ — $ 37 Years Ended December 31, 2023 2022 2021 Grant income recognized from COVID-19 relief programs: Included in grant income: Hospital Operations $ 15 $ 190 $ 142 Ambulatory Care 1 4 49 $ 16 $ 194 $ 191 Included in equity in earnings of unconsolidated affiliates: Unconsolidated affiliates $ — $ — $ 14 Years Ended December 31, 2022 2021 MAPP advances repaid or recouped: Included in cash flows from operating activities: Hospital Operations $ 876 $ 457 Ambulatory Care 4 55 $ 880 $ 512 Included in cash flows from financing activities: Cash‑Managed Affiliates $ — $ 104
Schedule of Equity Method Investments	For investments acquired during the reported periods, amounts below include 100% of the investee’s results beginning on the date of our acquisition of the investment. December 31, 2023 2022 2021 Current assets $ 1,223 $ 1,142 $ 1,176 Noncurrent assets $ 1,355 $ 1,356 $ 1,390 Current liabilities $ (456) $ (479) $ (495) Noncurrent liabilities $ (917) $ (878) $ (855) Noncontrolling interests $ (670) $ (644) $ (659) Years Ended December 31, 2023 2022 2021 Net operating revenues $ 3,510 $ 3,360 $ 3,030 Net income $ 860 $ 805 $ 836 Net income attributable to the investees $ 484 $ 453 $ 499

EQUITY (Tables)

EQUITY (Tables)	12 Months Ended
	Dec. 31, 2023
Stockholders' Equity Note [Abstract]
Schedule of Share Repurchase Activity	The table below summarizes transactions completed under the repurchase program during the years ended December 31, 2023 and 2022: Period Total Number of Shares Purchased Average Price Paid per Share Total Number of Shares Purchased as Part of Publicly Announced Program Maximum Dollar Value of Shares That May Yet be Purchased Under the Program (In Thousands) (In Thousands) (In Millions) Inception through October 31, 2022 1,800 $ 41.81 1,800 $ 925 November 1 through November 30, 2022 4,089 $ 42.74 4,089 $ 750 December 1 through December 31, 2022 — $ — — $ 750 Inception through December 31, 2022 5,889 $ 42.45 5,889 January 1 through January 31, 2023 — $ — — $ 750 February 1 through February 28, 2023 — $ — — $ 750 March 1 through March 31, 2023 906 $ 55.03 906 $ 700 April 1 through April 30, 2023 — $ — — $ 700 May 1 through May 31, 2023 580 $ 69.17 580 $ 660 June 1 through June 30, 2023 — $ — — $ 660 July 1 through July 31, 2023 — $ — — $ 660 August 1 through August 31, 2023 — $ — — $ 660 September 1 through September 30, 2023 — $ — — $ 660 October 1 through October 31, 2023 — $ — — $ 660 November 1 through November 30, 2023 982 $ 67.12 982 $ 594 December 1 through December 31, 2023 644 $ 68.53 644 $ 550 Year ended December 31, 2023 3,112 $ 64.27 3,112

ACCOUNTS RECEIVABLE (Tables)

ACCOUNTS RECEIVABLE (Tables)	12 Months Ended
	Dec. 31, 2023
Accounts Receivable Additional Disclosures [Abstract]
Schedule of Components of Accounts Receivable	The principal components of accounts receivable are shown in the table below: December 31, 2023 2022 Patient accounts receivable $ 2,719 $ 2,746 Estimated future recoveries 148 149 Net cost reports and settlements receivable and valuation allowances 47 48 Accounts receivable, net $ 2,914 $ 2,943
Schedule of Location of Assets and Liabilities	The following table summarizes the amount and classification of assets and liabilities in the accompanying Consolidated Balance Sheets related to California’s provider fee program: December 31, 2023 2022 Assets: Other current assets $ 329 $ 367 Investments and other assets $ 334 $ 197 Liabilities: Other current liabilities $ 172 $ 145 Other long-term liabilities $ 135 $ 63
Schedule of Estimated Costs for Charity Care and Self-Pay Patients	The following table presents our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients: Years Ended December 31, 2023 2022 2021 Estimated costs for: Uninsured patients $ 499 $ 537 $ 650 Charity care patients 110 83 97 $ 609 $ 620 $ 747

CONTRACT BALANCES (Tables)

CONTRACT BALANCES (Tables)	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Opening and Closing Balances of Contracts Assets and Liabilities	The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows: Receivables Contract Assets – Contract Liabilities – Contract Liabilities – December 31, 2022 $ 37 $ 200 $ 110 $ 13 December 31, 2023 21 208 59 12 Increase (decrease) $ (16) $ 8 $ (51) $ (1) December 31, 2021 $ 28 $ 199 $ 955 $ 15 December 31, 2022 37 200 110 13 Increase (decrease) $ 9 $ 1 $ (845) $ (2) Contract Liabilities – Current Advances from Medicare December 31, 2021 $ 4 December 31, 2022 — Decrease $ (4)

ASSETS AND LIABILITIES HELD F_2

ASSETS AND LIABILITIES HELD FOR SALE (Tables)	12 Months Ended
	Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]
Schedule of Assets and Liabilities Classified as Held for Sale and Components of Business that have Been Disposed of or have Been Classified as Held for Sale	Assets and liabilities classified as held for sale at December 31, 2023 were comprised of the following: Accounts receivable $ 78 Other current assets 25 Investments and other long-term assets 26 Property and equipment 204 Other intangible assets 17 Goodwill 425 Current liabilities (45) Long-term liabilities (24) Net assets held for sale $ 706 The following table presents amounts included in income from continuing operations, before income taxes, related to significant components of our business that were recently disposed of or were classified as held for sale at December 31, 2023: Years Ended December 31, 2023 2022 2021 Significant disposals: Income (loss) from continuing operations, before income taxes: Miami Hospitals (includes a $406 million gain on sale in 2021) $ (3) $ 10 $ 455 Significant planned divestitures classified as held for sale: Income from continuing operations, before income taxes: SC Hospitals $ 130 $ 127 $ 135

LEASES (Tables)

LEASES (Tables)	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Schedule of Supplemental Balance Sheet Information Related To Leases	The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets: December 31, Component of Lease Balances Classification in Consolidated Balance Sheets 2023 2022 Assets: Operating lease assets Investments and other assets $ 1,083 $ 1,129 Finance lease assets Property and equipment, at cost, less accumulated depreciation and amortization 253 303 Total leased assets $ 1,336 $ 1,432 Liabilities: Operating lease liabilities: Current Other current liabilities $ 204 $ 207 Long-term Other long-term liabilities 1,007 1,046 Total operating lease liabilities 1,211 1,253 Finance lease liabilities: Current Current portion of long-term debt 84 99 Long-term Long-term debt, net of current portion 120 165 Total finance lease liabilities 204 264 Total lease liabilities $ 1,415 $ 1,517
Schedule of Additional Information Related to Lease Expense, Terms and Discount Rates, and Cash Flow Information	The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations: Component of Lease Expense Classification in Consolidated Statements of Operations Years Ended December 31, 2023 2022 2021 Operating lease expense Other operating expenses, net $ 259 $ 262 $ 241 Finance lease expense: Amortization of leased assets Depreciation and amortization 55 58 71 Interest on lease liabilities Interest expense 8 8 9 Total finance lease expense 63 66 80 Variable and short term-lease expense Other operating expenses, net 159 150 171 Total lease expense $ 481 $ 478 $ 492 The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table: Years Ended December 31, 2023 2022 2021 Weighted-average remaining lease term (years): Operating leases 7.6 8.0 7.5 Finance leases 6.0 5.5 5.7 Weighted-average discount rate: Operating leases 5.0 % 4.8 % 5.1 % Finance leases 6.5 % 5.9 % 5.4 % Cash flow and other information related to leases is included in the following table: Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash outflows from operating leases $ 258 $ 250 $ 237 Operating cash outflows from finance leases $ 13 $ 14 $ 12 Financing cash outflows from finance leases $ 107 $ 118 $ 140 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 168 $ 341 $ 176 Finance leases $ 55 $ 97 $ 136
Schedule of Operating Lease Liability Maturity	Future maturities of lease liabilities at December 31, 2023 are presented in the following table: Operating Leases Finance Leases Total 2024 $ 255 $ 95 $ 350 2025 225 54 279 2026 190 24 214 2027 165 9 174 2028 136 7 143 Later years 494 70 564 Total lease payments 1,465 259 1,724 Less: Imputed interest 254 55 309 Total lease obligations 1,211 204 1,415 Less: Current obligations 204 84 288 Long-term lease obligations $ 1,007 $ 120 $ 1,127
Schedule of Finance Lease Liability Maturity	Future maturities of lease liabilities at December 31, 2023 are presented in the following table: Operating Leases Finance Leases Total 2024 $ 255 $ 95 $ 350 2025 225 54 279 2026 190 24 214 2027 165 9 174 2028 136 7 143 Later years 494 70 564 Total lease payments 1,465 259 1,724 Less: Imputed interest 254 55 309 Total lease obligations 1,211 204 1,415 Less: Current obligations 204 84 288 Long-term lease obligations $ 1,007 $ 120 $ 1,127

LONG-TERM DEBT (Tables)

LONG-TERM DEBT (Tables)	12 Months Ended
	Dec. 31, 2023
Long-Term Debt and Lease Obligation [Abstract]
Schedule of Long-Term Debt	The table below presents our long‑term debt included in the accompanying Consolidated Balance Sheets: December 31, 2023 2022 Senior unsecured notes: 6.125% due 2028 $ 2,500 $ 2,500 6.875% due 2031 362 362 Senior secured first lien notes: 4.625% due July 2024 — 756 4.625% due September 2024 — 589 4.875% due 2026 2,100 2,100 5.125% due 2027 1,500 1,500 4.625% due 2028 600 600 4.250% due 2029 1,400 1,400 4.375% due 2030 1,450 1,450 6.125% due 2030 2,000 2,000 6.750% due 2031 1,350 — Senior secured second lien notes: 6.250% due 2027 1,500 1,500 Finance leases, mortgages and other notes 361 453 Unamortized issue costs and note discounts (121) (131) Long-term debt 15,002 15,079 Less: Current portion 120 145 Long-term debt, net of current portion $ 14,882 $ 14,934
Schedule of Future Long Term Debt Maturities	Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2023: Years Ending December 31, Later Years Total 2024 2025 2026 2027 2028 Long-term debt, including finance lease obligations $ 15,123 $ 120 $ 92 $ 2,149 $ 3,029 $ 3,114 $ 6,619

EMPLOYEE BENEFIT PLANS (Tables)

EMPLOYEE BENEFIT PLANS (Tables)	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Stock Option Activity	The following table summarizes stock option activity during the years ended December 31, 2023, 2022 and 2021: Number of Options Wtd. Avg. Aggregate Wtd. Avg (In Millions) Outstanding at December 31, 2020 912,531 $ 22.51 Exercised (391,533) $ 20.66 Outstanding at December 31, 2021 520,998 $ 23.90 Exercised (60,051) $ 28.26 Outstanding at December 31, 2022 460,947 $ 23.33 Exercised (76,507) $ 26.07 Outstanding at December 31, 2023 384,440 $ 22.79 $ 20 4.1 years
Schedule of Information About Stock Options by Range of Exercise Prices	The following table summarizes information about our outstanding stock options at December 31, 2023: Options Outstanding and Exercisable Range of Exercise Prices Number of Wtd. Avg. Wtd. Avg. $18.99 to $20.609 255,845 3.6 years $ 19.62 $20.61 to $35.430 128,595 5.1 years $ 29.07 384,440 4.1 years $ 22.79
Schedule of Restricted Stock Unit Activity	The following table summarizes RSU activity during the years ended December 31, 2023, 2022 and 2021: Restricted Wtd. Avg. Grant Date Fair Unvested at December 31, 2020 2,095,206 $ 25.87 Granted 900,018 $ 58.61 Vested (765,814) $ 30.51 Forfeited (58,208) $ 37.60 Unvested at December 31, 2021 2,171,202 $ 40.51 Granted 641,205 $ 80.79 Vested (1,187,384) $ 37.18 Forfeited (104,605) $ 53.58 Unvested at December 31, 2022 1,520,418 $ 66.36 Granted 759,590 $ 60.88 Performance-based adjustment 185,901 $ 48.97 Vested (954,401) $ 48.75 Forfeited (90,445) $ 64.61 Unvested at December 31, 2023 1,421,063 $ 66.46 The table below summarizes the time-based RSUs granted during the year ended December 31, 2023: No. of RSUs Granted Vesting Terms 309,282 RSUs will vest and be settled ratably over a three 42,626 RSUs will vest and be settled on the fifth anniversary of the grant date 42,100 RSUs granted to our non-employee directors for the 2023-2024 board service year, which vested immediately and will be settled on the third anniversary of the grant date 33,586 RSUs vested and settled in December 2023 20,707 RSUs will vest and be settled upon the relocation of one of our executive officers 2,007 RSUs will vest and be settled on the third anniversary of the grant date The table below summarizes the performance-based RSUs granted during the year ended December 31, 2023: No. of RSUs Granted Performance Period Potential Vesting Range Vesting Terms Minimum Maximum 301,562 RSUs will vest and be settled on the third anniversary of the grant date 2023 to 2025 — % 225 % 185,901 RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2020 7,720 RSUs will vest and be settled on the third anniversary of the grant date 2023 to 2025 — % 200 % The table below summarizes the time-based RSUs granted during the year ended December 31, 2022: No. of RSUs Granted Vesting Terms 237,381 RSUs will vest and be settled ratably over a three 53,716 RSUs were scheduled to vest and be settled ratably over 11 quarterly periods 35,482 RSUs granted to our non-employee directors for the 2022-2023 board service year vested immediately and will be settled on the third anniversary of the grant date 9,215 RSUs will vest and be settled ratably over a four 7,325 RSUs granted to a non-executive member of the board of directors for his service as chairman of the board; award vested and settled in December 2023 6,170 RSUs will vest and be settled evenly on the third and fourth anniversaries of the grant date 4,608 RSUs will vest and be settled on the second anniversary of the grant date The table below summarizes the time-based RSUs granted during the year ended December 31, 2021: No. of RSUs Granted Vesting Terms 263,180 RSUs will vest and be settled ratably over a three 189,215 RSUs were scheduled to vest and be settled ratably over eight quarterly periods from the grant date 53,341 RSUs will vest and be settled on the fourth anniversary of the grant date 38,366 RSUs granted to our non-employee directors for the 2021-2022 board service year, which vested immediately and will be settled on the third anniversary of the grant date 33,351 RSUs will vest and be settled on the third anniversary of the grant date 14,192 RSUs vested on December 31, 2021 and were settled in January 2022 8,509 RSUs, one-third of which will vest and be settled on the second anniversary of the grant date and the remainder of which will vest and be settled on the fourth anniversary 1,372 RSUs granted to a new member of our board of directors, which vested immediately and will be settled upon separation from the board The table below summarizes the performance-based RSUs granted during the year ended December 31, 2021: No. of RSUs Granted Performance Period Potential Vesting Range Vesting Terms Minimum Maximum 244,259 RSUs will vest and be settled on the third anniversary of the grant 2021 to 2023 — % 200 % 53,341 RSUs will vest and be settled on the fourth anniversary of the grant date 2021 to 2025 — % 200 % 892 RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018 The following table summarizes RSU activity under the USPI Management Equity Plan during the years ended December 31, 2023, 2022 and 2021: Restricted Wtd. Avg. Grant Date Fair Unvested at December 31, 2020 2,025,056 $ 34.13 Granted 76,990 $ 34.13 Vested (388,588) $ 34.13 Forfeited (218,576) $ 34.13 Unvested at December 31, 2021 1,494,882 $ 34.13 Vested (369,691) $ 34.13 Forfeited (202,351) $ 34.13 Unvested at December 31, 2022 922,840 $ 34.13 Vested (303,171) $ 34.13 Forfeited (11,685) $ 34.13 Unvested at December 31, 2023 607,984 $ 34.13
Schedule of Share-based Payment Award, Awards Other Than Options, Valuation Assumptions	Significant inputs used in our valuation of these RSUs included the following: Years Ended December 31, 2023 2022 2021 Expected volatility 53.6% - 65.6% 39.6% - 68.1% 65.2% - 79.3% Risk-free interest rate 4.2% - 4.8% 1.0% - 1.7% 0.1% - 0.6%
Schedule of Employee Stock Purchase Plan Activity	We issued the following numbers of shares under our employee stock purchase plan: Years Ended December 31, 2023 2022 2021 Number of shares (in thousands) 69 98 90 Weighted average price $ 65.62 $ 54.19 $ 63.01
Schedule of Reconciliation of Funded Status of Plans, the Amounts included in the Consolidated Balance Sheets and Assumptions Used for Projected Benefit Obligations	The following tables summarize the balance sheet impact, as well as the benefit obligations, funded status and rate assumptions associated with the SERPs and the DMC Pension Plan based on actuarial valuations prepared: December 31, 2023 2022 Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets: Projected benefit obligations (1) Beginning obligations $ (1,002) $ (1,313) Interest cost (53) (37) Actuarial gain (loss) (15) 265 Benefits paid 84 83 Annuity purchase 36 — Special termination benefit costs (1) — Ending obligations (951) (1,002) Fair value of plans assets Beginning plan assets 648 867 Gain (loss) on plan assets 41 (161) Employer contribution — 2 Benefits paid (61) (60) Annuity purchase (36) — Ending plan assets 592 648 Funded status of plans $ (359) $ (354) Amounts recognized in the Consolidated Balance Sheets consist of: Other current liability $ (24) $ (23) Other long-term liability $ (335) $ (331) Accumulated other comprehensive loss $ 224 $ 222 SERP Assumptions: Discount rate 5.50 % 5.75 % Compensation increase rate 3.00 % 3.00 % Measurement date December 31, 2023 December 31, 2022 DMC Pension Plan Assumptions: Discount rate 5.25 % 5.51 % Compensation increase rate Frozen Frozen Measurement date December 31, 2023 December 31, 2022 (1) The accumulated benefit obligation at December 31, 2023 and 2022 was approximately $951 million and $1.002 billion, respectively.
Schedule of Components of Net Benefit Costs and Assumptions Used for Net Periodic Benefit Costs	The components of net periodic benefit costs and related assumptions are as follows: Years Ended December 31, 2023 2022 2021 Interest costs $ 53 $ 37 $ 36 Expected return on plan assets (36) (42) (53) Amortization of net actuarial loss 7 9 11 Special termination benefit costs 1 — — Net periodic benefit cost (income) $ 25 $ 4 $ (6) SERP Assumptions: Discount rate 5.75 % 3.00 % 2.75 % Compensation increase rate 3.00 % 3.00 % 3.00 % Measurement date January 1, 2023 January 1, 2022 January 1, 2021 Census date January 1, 2023 January 1, 2022 January 1, 2021 DMC Pension Plan Assumptions: Discount rate 5.51 % 2.89 % 2.53 % Long-term rate of return on assets 5.75 % 5.00 % 6.25 % Compensation increase rate Frozen Frozen Frozen Measurement date January 1, 2023 January 1, 2022 January 1, 2021 Census date January 1, 2023 January 1, 2022 January 1, 2021
Schedule of Weighted-Average Asset Allocations by Asset Category	The weighted‑average asset allocations by asset category as of December 31, 2023, were as follows: Target Actual Cash and cash equivalents — % 1 % Equity securities 20 % 6 % Debt securities 73 % 75 % Alternative investments 7 % 18 %
Schedule of DMC Pension Plan Assets Measured at Fair Value on a Recurring Basis Aggregated by the Level in the Fair Value Hierarchy	The following tables summarize the DMC Pension Plan assets measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements are determined: Total Level 1 Level 2 Level 3 As of December 31, 2023: Cash and cash equivalents $ 6 $ 6 $ — $ — Equity securities 39 39 — — Fixed income funds 442 442 — — Alternative investments: Private equity securities 97 — — 97 Hedge funds 8 — — 8 $ 592 $ 487 $ — $ 105 As of December 31, 2022: Cash and cash equivalents $ 7 $ 7 $ — $ — Equity securities 89 89 — — Debt Securities: U.S. government obligations 200 200 — — Corporate debt securities 249 249 — — Alternative investments: Private equity securities 78 — — 78 Hedge funds 25 — — 25 $ 648 $ 545 $ — $ 103
Schedule of Estimated Future Benefit Payments	The following table presents the estimated future benefit payments to be made from the SERPs and the DMC Pension Plan, a portion of which will be funded from plan assets, for the next five years and in the aggregate for the five years thereafter: Years Ending December 31, Five Years Thereafter Total 2024 2025 2026 2027 2028 Estimated benefit payments $ 789 $ 84 $ 84 $ 83 $ 82 $ 81 $ 375

PROPERTY AND EQUIPMENT (Tables)

PROPERTY AND EQUIPMENT (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Schedule of Components of Property and Equipment	The principal components of property and equipment are shown in the table below: December 31, 2023 2022 Land $ 625 $ 661 Buildings and improvements 6,692 6,646 Construction in progress 269 195 Equipment 4,750 4,748 Finance lease assets 378 413 12,714 12,663 Accumulated depreciation and amortization (6,478) (6,201) Net property and equipment $ 6,236 $ 6,462

GOODWILL AND OTHER INTANGIBLE_2

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in the Carrying Amount of Goodwill	The following table provides information on changes in the carrying amount of goodwill: December 31, 2023 2022 Hospital Operations Goodwill at beginning of period, net of accumulated impairment losses $ 3,411 $ 3,413 Goodwill acquired during the year 133 1 Goodwill related to assets held for sale and disposed (425) (3) Goodwill at end of period, net of accumulated impairment losses $ 3,119 $ 3,411 Ambulatory Care Goodwill at beginning of period $ 6,712 $ 5,848 Goodwill acquired during the year and purchase price allocation adjustments 493 866 Goodwill related to assets held for sale and disposed or deconsolidated facilities (17) (2) Goodwill at end of period $ 7,188 $ 6,712
Schedule of Other Intangible Assets	The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets: Gross Accumulated Net Book At December 31, 2023: Other intangible assets with finite useful lives: Capitalized software costs $ 1,712 $ (1,205) $ 507 Contracts 294 (164) 130 Other 91 (78) 13 Other intangible assets with finite lives 2,097 (1,447) 650 Other intangible assets with indefinite useful lives: Trade names 105 — 105 Contracts 609 — 609 Other 4 — 4 Other intangible assets with indefinite lives 718 — 718 Other intangible assets, net $ 2,815 $ (1,447) $ 1,368 At December 31, 2022: Other intangible assets with finite useful lives: Capitalized software costs $ 1,751 $ (1,206) $ 545 Contracts 295 (146) 149 Other 92 (76) 16 Total other intangible assets with finite lives 2,138 (1,428) 710 Other intangible assets with indefinite useful lives: Trade names 105 — 105 Contracts 603 — 603 Other 6 — 6 Total other intangible assets with indefinite lives 714 — 714 Total other intangible assets, net $ 2,852 $ (1,428) $ 1,424
Schedule of Estimated Future Amortization of Intangibles with Finite Useful Lives	Estimated future amortization of intangible assets with finite useful lives at December 31, 2023 was as follows: Total Years Ending December 31, Later Years 2024 2025 2026 2027 2028 Amortization of intangible assets $ 650 $ 132 $ 124 $ 99 $ 84 $ 61 $ 150

OTHER ASSETS (Tables)

OTHER ASSETS (Tables)	12 Months Ended
	Dec. 31, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Other Current Assets	The principal components of other current assets in the accompanying Consolidated Balance Sheets were as follows: December 31, 2023 2022 Prepaid expenses $ 391 $ 400 Contract assets 208 200 California provider fee program receivables 329 367 Receivables from other government programs 282 187 Guarantees 274 143 Non-patient receivables 260 390 Other 95 88 Total other current assets $ 1,839 $ 1,775
Schedule of Investments and Other Assets	The principal components of investments and other assets in the accompanying Consolidated Balance Sheets were as follows: December 31, 2023 2022 Marketable securities $ 48 $ 30 Equity investments in unconsolidated healthcare entities 1,512 1,599 Total investments 1,560 1,629 Cash surrender value of life insurance policies 43 37 Long-term deposits 50 56 California provider fee program receivables 334 197 Operating lease assets 1,083 1,129 Other long-term receivables and other assets 87 99 Total investments and other assets $ 3,157 $ 3,147

ACCUMULATED OTHER COMPREHENSI_2

ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)	12 Months Ended
	Dec. 31, 2023
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Schedule of Accumulated Other Comprehensive Loss	The table below presents our accumulated other comprehensive loss by component: December 31, 2023 2022 Adjustments for defined benefit plans $ (180) $ (178) Unrealized gains on investments (1) (3) Accumulated other comprehensive loss $ (181) $ (181) The following table presents the income tax expense (benefit) from each component of our other comprehensive income: December 31, 2023 2022 Adjustments for defined benefit plans $ — $ 18 Foreign currency translation adjustments and other — (1) Net income tax expense related to items of other comprehensive income $ — $ 17

NET OPERATING REVENUES - (Table

NET OPERATING REVENUES - (Tables)	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Sources of Net Operating Revenues Less Provisions for Doubtful Accounts and Implicit Price Concessions	The table below presents our sources of net operating revenues: Years Ended December 31, 2023 2022 2021 Hospital Operations: Net patient service revenues from hospitals and related outpatient facilities: Medicare $ 2,383 $ 2,369 $ 2,615 Medicaid 1,233 1,069 1,254 Managed care 10,248 9,607 9,985 Uninsured 96 141 199 Indemnity and other 590 661 706 Total 14,550 13,847 14,759 Other revenues (1) 2,133 2,079 2,008 Total Hospital Operations 16,683 15,926 16,767 Ambulatory Care 3,865 3,248 2,718 Net operating revenues $ 20,548 $ 19,174 $ 19,485 (1) Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure. The following table presents the composition of net operating revenues for our Ambulatory Care segment: Years Ended December 31, 2023 2022 2021 Net patient service revenues $ 3,713 $ 3,115 $ 2,604 Management fees 123 110 86 Revenue from other sources 29 23 28 Net operating revenues $ 3,865 $ 3,248 $ 2,718
Schedule of Revenue Expected to be Recognized in the Future Related to Performance Obligations	The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032. Years Ending December 31, Later Years Total 2024 2025 2026 2027 2028 Performance obligations $ 6,026 $ 685 $ 684 $ 683 $ 683 $ 683 $ 2,608

CLAIMS AND LAWSUITS (Tables)

CLAIMS AND LAWSUITS (Tables)	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Schedule of Reconciliations Of Legal Settlements And Related Costs	The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs: Balances at Litigation and Cash Other Balances at Year Ended December 31, 2023 $ 51 $ 47 $ (59) $ 1 $ 40 Year Ended December 31, 2022 $ 78 $ 70 $ (100) $ 3 $ 51 Year Ended December 31, 2021 $ 26 $ 116 $ (59) $ (5) $ 78

REDEEMABLE NONCONTROLLING INT_2

REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES (Tables)	12 Months Ended
	Dec. 31, 2023
Noncontrolling Interest [Abstract]
Schedule of Changes in Redeemable Noncontrolling Interests in Equity of Consolidated Subsidiaries	The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries: December 31, 2023 2022 Balances at beginning of period $ 2,149 $ 2,203 Net income 366 348 Distributions paid to noncontrolling interests (305) (331) Accretion of redeemable noncontrolling interests — 104 Purchases and sales of businesses and noncontrolling interests, net 181 (175) Balances at end of period $ 2,391 $ 2,149 The following tables show the composition by segment of our redeemable noncontrolling interests balances, as well as our net income available to redeemable noncontrolling interests: December 31, 2023 2022 Hospital Operations $ 860 $ 792 Ambulatory Care 1,531 1,357 Redeemable noncontrolling interests $ 2,391 $ 2,149 Years Ended December 31, 2023 2022 2021 Hospital Operations $ 84 $ 100 $ 93 Ambulatory Care 282 248 243 Net income available to redeemable noncontrolling interests $ 366 $ 348 $ 336

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Provision for Income Taxes For Continuing Operations	The provision for income taxes for continuing operations for the years ended December 31, 2023, 2022 and 2021 consisted of the following: Years Ended December 31, 2023 2022 2021 Current tax expense: Federal $ 208 $ 78 $ 50 State 46 57 111 254 135 161 Deferred tax expense (benefit): Federal 55 174 267 State (3) 35 (17) 52 209 250 $ 306 $ 344 $ 411
Schedule of Reconciliation Between Reported Income Tax Expense (Benefit) and Income Taxes Calculated by the Statutory Federal Income Tax Rate	A reconciliation between the amount of reported income tax expense and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal tax rate is presented below. Foreign pre-tax loss was $3 million, $8 million and $5 million for the years ended December 31, 2023, 2022 and 2021, respectively. Years Ended December 31, 2023 2022 2021 Tax expense at statutory federal rate of 21% $ 340 $ 282 $ 396 State income taxes, net of federal income tax benefit 70 64 77 Tax benefit attributable to noncontrolling interests (147) (122) (114) Nondeductible goodwill — 1 35 Nondeductible executive compensation 6 10 8 Impact of change in state filing method, net of change in unrecognized tax benefit (20) — — Nondeductible litigation costs — — 1 Stock-based compensation tax benefit (2) (6) (5) Changes in valuation allowance 71 120 2 Prior-year provision to return adjustments and other changes in deferred taxes (9) (12) 8 Other items (3) 7 3 Income tax expense $ 306 $ 344 $ 411
Schedule of Components of Deferred Tax Assets and Liabilities, Including Any Valuation Allowance	The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance: December 31, 2023 December 31, 2022 Assets Liabilities Assets Liabilities Depreciation and fixed-asset differences $ — $ 430 $ — $ 436 Reserves related to discontinued operations and restructuring charges 6 — 5 — Receivables (doubtful accounts and adjustments) 222 — 246 — Medicare advance payments — — — — Accruals for retained insurance risks 232 — 227 — Intangible assets — 429 — 416 Other long-term liabilities 32 — 27 — Benefit plans 233 — 207 — Other accrued liabilities 20 — 30 — Investments and other assets — 119 — 112 Interest expense limitation 206 — 133 — Net operating loss carryforwards 71 — 74 — Stock-based compensation 13 — 13 — Right-of-use lease assets and obligations 129 111 192 173 Other items 4 80 11 49 1,168 1,169 1,165 1,186 Valuation allowance (248) — (177) — $ 920 $ 1,169 $ 988 $ 1,186
Schedule of Reconciliation of the Deferred Tax Assets and Liabilities and the Corresponding Amounts Reported in the Accompanying Consolidated Balance Sheets	Below is a reconciliation of the deferred tax assets and liabilities and the corresponding amounts reported in the accompanying Consolidated Balance Sheets: December 31, 2023 2022 Deferred income tax assets $ 77 $ 19 Deferred tax liabilities (326) (217) Net deferred tax liability $ (249) $ (198)
Schedule of Changes in Unrecognized Tax Benefits That Have Impacted Deferred Tax Assets and Liabilities	The following table summarizes the total changes in unrecognized tax benefits in continuing operations during the years ended December 31, 2023, 2022 and 2021. There were no such changes in discontinued operations. The additions and reductions for tax positions include the impact of items for which the ultimate deductibility is highly certain, but for which there is uncertainty about the timing of such deductions. Such amounts include unrecognized tax benefits that have impacted deferred tax assets and liabilities at December 31, 2023, 2022 and 2021. Continuing Balance At December 31, 2020 $ 31 Reductions due to a lapse of statute of limitations 3 Balance At December 31, 2021 $ 34 Reductions due to a lapse of statute of limitations — Balance At December 31, 2022 $ 34 Increases due to tax positions taken in prior periods 31 Reductions due to a lapse of statute of limitations (1) Balance At December 31, 2023 $ 64

EARNINGS PER COMMON SHARE (Tabl

EARNINGS PER COMMON SHARE (Tables)	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Schedule of Reconciliation of Numerators and Denominators of our Basic and Diluted Earnings Per Common Share	The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings per common share calculations for our continuing operations. Net income available to our common shareholders is expressed in millions and weighted average shares are expressed in thousands. Net Income Available to Common Shareholders (Numerator) Weighted Per-Share Year Ended December 31, 2023 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 611 101,639 $ 6.01 Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock (13) 3,161 (0.30) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 598 104,800 $ 5.71 Year Ended December 31, 2022 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 410 106,929 $ 3.83 Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock 8 3,587 (0.05) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 418 110,516 $ 3.78 Year Ended December 31, 2021 Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 915 106,833 $ 8.56 Effect of dilutive stock options, restricted stock units and deferred compensation units — 1,738 (0.13) Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 915 108,571 $ 8.43

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Non-Recurring Basis	The following table presents this information about assets measured at fair value at December 31, 2023 and 2022 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values: Total Quoted Prices Significant Other Significant December 31, 2023 Long-lived assets held for sale $ 775 $ — $ 775 $ — December 31, 2022 Long-lived assets held and used $ 167 $ — $ 167 $ —

ACQUISITIONS (Tables)

ACQUISITIONS (Tables)	12 Months Ended
	Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Schedule of Preliminary Purchase Price Allocation	Preliminary or final purchase price allocations for all the acquisitions made during the years ended December 31, 2023, 2022 and 2021 are as follows: Years Ended December 31, 2023 2022 2021 Current assets $ 34 $ 38 $ 59 Property and equipment 28 54 88 Other intangible assets 5 2 8 Goodwill 644 860 664 Other long-term assets 32 99 796 Previously held equity method investments (99) (207) (43) Current liabilities (36) (41) (25) Long-term liabilities (37) (118) (70) Redeemable noncontrolling interests in equity of consolidated subsidiaries (229) (180) (139) Noncontrolling interests (102) (273) (95) Cash paid, net of cash acquired (224) (234) (1,220) Gains on consolidations $ 16 $ — $ 23

SEGMENT INFORMATION (Tables)

SEGMENT INFORMATION (Tables)	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Schedule of Reconciliation of Assets by Reportable Segment to Consolidated Assets	The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Consolidated Balance Sheets and Consolidated Statements of Operations, as applicable: December 31, 2023 2022 2021 Assets: Hospital Operations $ 17,268 $ 16,599 $ 18,106 Ambulatory Care 11,044 10,557 9,473 Total $ 28,312 $ 27,156 $ 27,579
Schedule of Reconciliation of Other Significant Reconciling Items From Segments to Consolidated	Years Ended December 31, 2023 2022 2021 Capital expenditures: Hospital Operations $ 671 $ 687 $ 592 Ambulatory Care 80 75 66 Total $ 751 $ 762 $ 658 Net operating revenues: Hospital Operations $ 16,683 $ 15,926 $ 16,767 Ambulatory Care 3,865 3,248 2,718 Total $ 20,548 $ 19,174 $ 19,485 Equity in earnings of unconsolidated affiliates: Hospital Operations $ 10 $ 10 $ 25 Ambulatory Care 218 206 193 Total $ 228 $ 216 $ 218 Adjusted EBITDA: Hospital Operations $ 1,997 $ 2,142 $ 2,286 Ambulatory Care 1,544 1,327 1,197 Total $ 3,541 $ 3,469 $ 3,483 Depreciation and amortization: Hospital Operations $ 750 $ 729 $ 760 Ambulatory Care 120 112 95 Total $ 870 $ 841 $ 855 Years Ended December 31, 2023 2022 2021 Adjusted EBITDA $ 3,541 $ 3,469 $ 3,483 Loss from divested and closed businesses — — (1) Depreciation and amortization (870) (841) (855) Impairment and restructuring charges, and acquisition-related costs (137) (226) (85) Litigation and investigation costs (47) (70) (116) Interest expense (901) (890) (923) Loss from early extinguishment of debt (11) (109) (74) Other non-operating income, net 19 10 14 Gains on sales, consolidation and deconsolidation of facilities 23 1 445 Income from continuing operations, before income taxes $ 1,617 $ 1,344 $ 1,888

SIGNIFICANT ACCOUNTING POLICI_4

SIGNIFICANT ACCOUNTING POLICIES - Description of Business (Details) $ in Millions	1 Months Ended	12 Months Ended
	Jun. 30, 2022 USD ($)	Dec. 31, 2023 healthcare_facility hospital segment	Dec. 31, 2022 segment	Jun. 29, 2022
Business Acquisition [Line Items]
Number of reportable segments | segment		2	3
Number of acute care and specialty hospitals operated | hospital		61
Hospital Operations
Business Acquisition [Line Items]
Number of outpatient facilities operated | healthcare_facility		164
Ambulatory Care
Business Acquisition [Line Items]
Number of outpatient centers recorded using equity method | healthcare_facility		155
United Surgical Partners International | Ambulatory Care
Business Acquisition [Line Items]
Ownership percentage by parent (percent)	100%			95%
United Surgical Partners International | Ambulatory Care
Business Acquisition [Line Items]
Number of ambulatory surgery centers | hospital		461
Number of surgical hospitals operated by subsidiaries | hospital		24
Number of outpatient centers recorded using equity method | healthcare_facility		155
Baylor University Medical Center | United Surgical Partners International
Business Acquisition [Line Items]
Share purchase agreement amount of payment | $	$ 406

SIGNIFICANT ACCOUNTING POLICI_5

SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Diluted (in shares)	104,800	110,516	108,571
Earnings per share, diluted (in dollars per share)	$ 5.71	$ 3.79	$ 8.42
Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06
Business Acquisition [Line Items]
Diluted (in shares)	2,364	2,673
Earnings per share, diluted (in dollars per share)	$ (0.26)	$ (0.01)

SIGNIFICANT ACCOUNTING POLICI_6

SIGNIFICANT ACCOUNTING POLICIES - COVID-19 Pandemic (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Received cash payments	$ 10,000,000	$ 196,000,000	$ 178,000,000
Grant income	16,000,000	194,000,000	191,000,000
Deferred revenue	0	7,000,000
Contract liabilities advance payments		880,000,000	512,000,000
Accrued Compensation And Benefits
Business Acquisition [Line Items]
Deferred social security tax payments		128,000,000	128,000,000
Hospital Operations
Business Acquisition [Line Items]
Received cash payments	10,000,000	193,000,000	142,000,000
Grant income	15,000,000	190,000,000	142,000,000
Contract liabilities advance payments		876,000,000	457,000,000
Contract liabilities	59,000,000	110,000,000	955,000,000
Ambulatory Care
Business Acquisition [Line Items]
Received cash payments	0	3,000,000	36,000,000
Grant income	1,000,000	4,000,000	49,000,000
Contract liabilities advance payments		4,000,000	55,000,000
Contract liabilities	0	0	4,000,000
Hospital Operations And Ambulatory Care
Business Acquisition [Line Items]
Contract liabilities	0	0
Cash‑Managed Affiliates
Business Acquisition [Line Items]
Received cash payments	0	0	37,000,000
Contract liabilities advance payments		0	104,000,000
Unconsolidated affiliates | Ambulatory Care
Business Acquisition [Line Items]
Grant income	$ 0	$ 0	$ 14,000,000

SIGNIFICANT ACCOUNTING POLICI_7

SIGNIFICANT ACCOUNTING POLICIES - Net Operating Revenues (Details)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Cost report filing period after end of annual cost reporting period	5 months
Percentage of contract assets that meet the conditions for unconditional right to payment (percentage)	88%

SIGNIFICANT ACCOUNTING POLICI_8

SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($) $ in Millions	1 Months Ended	12 Months Ended
	Jun. 30, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash and Cash Equivalents
Cash and cash equivalents		$ 1,228	$ 858
Accrued property and equipment purchases for items received but not yet paid		154	196	$ 95
United Surgical Partners International
Cash and Cash Equivalents
Purchase and sales of business and noncontrolling interest, net	$ 365
Loss from purchase of noncontrolling interests	23
Baylor University Medical Center | United Surgical Partners International
Cash and Cash Equivalents
Share purchase agreement, payment for execution	11
Debt instrument payment	$ 377
Baylor University Medical Center | United Surgical Partners International | Put Option
Cash and Cash Equivalents
Ownership percentage	5%
Captive Insurance Subsidiaries
Cash and Cash Equivalents
Cash and cash equivalents		100	140
Accounts Payable
Cash and Cash Equivalents
Book overdrafts classified as accounts payable		187	266
Accrued property and equipment purchases for items received but not yet paid		$ 141	$ 191	$ 88

SIGNIFICANT ACCOUNTING POLICI_9

SIGNIFICANT ACCOUNTING POLICIES - Investments in Unconsolidated Affiliates (Details) $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($) healthcare_facility	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Schedule of Equity Method Investments [Line Items]
Grant income	$ 16	$ 194	$ 191
Percentage of investee results reflected on date of acquisition	1
Current assets	$ 7,167	5,981
Current liabilities	(4,760)	(4,476)
Noncontrolling interests	(1,509)	(1,317)
Net operating revenues	20,548	19,174	19,485
Net income	1,311	1,001	1,476
Equity in earnings of unconsolidated affiliates	228	216	218
Unconsolidated affiliates
Schedule of Equity Method Investments [Line Items]
Current assets	1,223	1,142	1,176
Noncurrent assets	1,355	1,356	1,390
Current liabilities	(456)	(479)	(495)
Noncurrent liabilities	(917)	(878)	(855)
Noncontrolling interests	(670)	(644)	(659)
Net operating revenues	3,510	3,360	3,030
Net income	860	805	836
Net income attributable to the investees	484	453	499
Texas Health Ventures Group, LLC
Schedule of Equity Method Investments [Line Items]
Equity in earnings of unconsolidated affiliates	$ 104	89	107
Ambulatory Care
Schedule of Equity Method Investments [Line Items]
Number of outpatient centers recorded not using equity method | healthcare_facility	330
Number of outpatient centers recorded using equity method | healthcare_facility	155
Number Out Patient Centers, Ownership Interest | healthcare_facility	485
Grant income	$ 1	4	49
Net operating revenues	3,865	3,248	2,718
Equity in earnings of unconsolidated affiliates	218	206	193
Ambulatory Care | Unconsolidated affiliates
Schedule of Equity Method Investments [Line Items]
Grant income	$ 0	$ 0	$ 14

SIGNIFICANT ACCOUNTING POLIC_10

SIGNIFICANT ACCOUNTING POLICIES - Property and Equipment (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Buildings and improvements | Minimum
Property and equipment
Useful life	15 years
Buildings and improvements | Maximum
Property and equipment
Useful life	40 years
Equipment | Minimum
Property and equipment
Useful life	3 years
Equipment | Maximum
Property and equipment
Useful life	15 years
Newly Constructed Hospitals
Property and equipment
Useful life	50 years
Construction in progress
Property and equipment
Interest costs capitalized related to construction projects	$ 9	$ 8	$ 4

SIGNIFICANT ACCOUNTING POLIC_11

SIGNIFICANT ACCOUNTING POLICIES - Leases (Details)	Dec. 31, 2023 renewal_option
Property and equipment
Number of renewal options	1
Minimum
Property and equipment
Operating lease, renewal term	5 years
Maximum
Property and equipment
Operating lease, renewal term	10 years
Real estate | Minimum
Property and equipment
Operating lease, term of contract	5 years
Real estate | Maximum
Property and equipment
Operating lease, term of contract	10 years
Equipment
Property and equipment
Operating lease, term of contract	3 years
Equipment | Minimum
Property and equipment
Useful life	3 years
Equipment | Maximum
Property and equipment
Useful life	15 years
Medical Equipment
Property and equipment
Operating lease, term of contract	3 years
Medical Equipment | Minimum
Property and equipment
Useful life	5 years
Medical Equipment | Maximum
Property and equipment
Useful life	7 years
Computer And Telecommunication Equipment
Property and equipment
Useful life	15 years

SIGNIFICANT ACCOUNTING POLIC_12

SIGNIFICANT ACCOUNTING POLICIES - Goodwill and Other Intangible Assets (Details) - Capitalized software costs	Dec. 31, 2023
Minimum
Goodwill and Other Intangible Assets
Estimated useful life	3 years
Maximum
Goodwill and Other Intangible Assets
Estimated useful life	15 years

SIGNIFICANT ACCOUNTING POLIC_13

SIGNIFICANT ACCOUNTING POLICIES - Segment Reporting (Details)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Revenue generated by general hospitals	81%	83%	86%

EQUITY - Noncontrolling Interes

EQUITY - Noncontrolling Interests (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Noncontrolling Interest [Line Items]
Noncontrolling interests balance	$ 3,117	$ 2,459	$ 2,054	$ 937
Net income attributable to noncontrolling interests	945	653	1,140
Noncontrolling Interests
Noncontrolling Interest [Line Items]
Noncontrolling interests balance	1,509	1,317	1,026	$ 909
Net income attributable to noncontrolling interests	334	242	226
Noncontrolling Interests | Hospital Operations
Noncontrolling Interest [Line Items]
Noncontrolling interests balance	185	132
Net income attributable to noncontrolling interests	30	21	21
Noncontrolling Interests | Ambulatory Care
Noncontrolling Interest [Line Items]
Noncontrolling interests balance	1,324	1,185
Net income attributable to noncontrolling interests	$ 304	$ 221	$ 205

EQUITY - Share Repurchase Progr

EQUITY - Share Repurchase Programs (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions		1 Months Ended														2 Months Ended	12 Months Ended
	Oct. 31, 2022	Dec. 31, 2023	Nov. 30, 2023	Oct. 31, 2023	Sep. 30, 2023	Aug. 31, 2023	Jul. 31, 2023	Jun. 30, 2023	May 31, 2023	Apr. 30, 2023	Mar. 31, 2023	Feb. 28, 2023	Jan. 31, 2023	Dec. 31, 2022	Nov. 30, 2022	Dec. 31, 2022	Dec. 31, 2023	Oct. 22, 2022
Equity, Class of Treasury Stock [Line Items]
Amount of common stock authorized to be repurchased																		$ 1,000
Total Number of Shares Purchased (in shares)	1,800	644		0	0	0	0	0	580	0	906	0	0	0	4,089	5,889	3,112
Average Price Paid per Share (in dollars per shares)	$ 41.81	$ 68.53	$ 67.12	$ 0	$ 0	$ 0	$ 0	$ 0	$ 69.17	$ 0	$ 55.03	$ 0	$ 0	$ 0	$ 42.74	$ 42.45	$ 64.27
Maximum Dollar Value of Shares That May Yet be Purchased Under the Program	$ 925	$ 550	$ 594	$ 660	$ 660	$ 660	$ 660	$ 660	$ 660	$ 700	$ 700	$ 750	$ 750	$ 750	$ 750	$ 750	$ 550
Publicly Announced Share Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Total Number of Shares Purchased (in shares)	1,800	644	982	0	0	0	0	0	580	0	906	0	0	0	4,089	5,889	3,112

ACCOUNTS RECEIVABLE - Component

ACCOUNTS RECEIVABLE - Components (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Accounts Receivable Additional Disclosures [Abstract]
Patient accounts receivable	$ 2,719	$ 2,746
Estimated future recoveries	148	149
Net cost reports and settlements receivable and valuation allowances	47	48
Accounts receivable, net	$ 2,914	$ 2,943

ACCOUNTS RECEIVABLE - Location

ACCOUNTS RECEIVABLE - Location of Assets and Liabilities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Assets:
Other current assets	$ 1,839	$ 1,775
Investments and other assets	3,157	3,147
Liabilities:
Other current liabilities	1,779	1,581
Other long-term liabilities	1,709	1,800
California's Provider Fee Program
Assets:
Other current assets	329	367
Investments and other assets	334	197
Liabilities:
Other current liabilities	172	145
Other long-term liabilities	$ 135	$ 63

ACCOUNTS RECEIVABLE - Allowance

ACCOUNTS RECEIVABLE - Allowance (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounts receivable and allowance for doubtful accounts
Estimated costs of caring	$ 609	$ 620	$ 747
Uninsured patients
Accounts receivable and allowance for doubtful accounts
Estimated costs of caring	499	537	650
Charity care patients
Accounts receivable and allowance for doubtful accounts
Estimated costs of caring	$ 110	$ 83	$ 97

CONTRACT BALANCES - Hospital Op

CONTRACT BALANCES - Hospital Operations and Ambulatory Care Segments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Contract Assets – Unbilled Revenue
Balance at beginning of period	$ 200,000,000
Balance at end of period	208,000,000	$ 200,000,000
Hospital Operations
Receivables
Balance at beginning of period	37,000,000	28,000,000
Balance at end of period	21,000,000	37,000,000
Increase (decrease)	(16,000,000)	9,000,000
Contract Assets – Unbilled Revenue
Balance at beginning of period	200,000,000	199,000,000
Balance at end of period	208,000,000	200,000,000
Increase (decrease)	8,000,000	1,000,000
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Balance at beginning of period	110,000,000	955,000,000
Balance at end of period	59,000,000	110,000,000
Contract Liabilities – Long-Term Deferred Revenue
Balance at beginning of period	13,000,000	15,000,000
Balance at end of period	12,000,000	13,000,000
Contract liabilities advance payments	71,000,000	56,000,000
Hospital Operations | Medicare Advances
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Balance at beginning of period		876,000,000
Hospital Operations | Short-term Contract with Customer
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Increase (decrease)	(51,000,000)	(845,000,000)
Contract Liabilities – Long-Term Deferred Revenue
Increase (decrease)	(51,000,000)	(845,000,000)
Hospital Operations | Long-term Contract with Customer
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Increase (decrease)	(1,000,000)	(2,000,000)
Contract Liabilities – Long-Term Deferred Revenue
Increase (decrease)	(1,000,000)	(2,000,000)
Ambulatory Care
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Balance at beginning of period	0	4,000,000
Balance at end of period	$ 0	0
Ambulatory Care | Short-term Contract with Customer
Contract Liabilities – Current Deferred Revenue and Advances from Medicare
Increase (decrease)		(4,000,000)
Contract Liabilities – Long-Term Deferred Revenue
Increase (decrease)		$ (4,000,000)

CONTRACT BALANCES - Contract Co

CONTRACT BALANCES - Contract Costs (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Amortized customer contract costs	$ 5	$ 4	$ 4
Unamortized contract costs	$ 22	$ 24

ASSETS AND LIABILITIES HELD F_3

ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details)	1 Months Ended		12 Months Ended
	Nov. 30, 2023 hospital	Aug. 31, 2021 hospital	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Jan. 31, 2024 USD ($)	Jan. 31, 2023
Current Assets and Liabilities Held for Sale
Impairment charges			$ 43,000,000	$ 94,000,000	$ 8,000,000
Discontinued Operations, Held-for-sale
Current Assets and Liabilities Held for Sale
Impairment charges			$ 0	$ 0	0
Discontinued Operations, Held-for-sale | San Ramon RMC
Current Assets and Liabilities Held for Sale
Ownership percentage of subsidiary							51%
SC Hospitals | Discontinued Operations, Held-for-sale
Current Assets and Liabilities Held for Sale
Number of hospitals for sale | hospital	3
SC Hospitals | Discontinued Operations, Held-for-sale | Subsequent Event
Current Assets and Liabilities Held for Sale
Proceeds received						$ 2,400,000,000
Miami-Area Hospitals | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Current Assets and Liabilities Held for Sale
Number of hospitals for sale | hospital		5
Gain (loss) on sale of properties					406,000,000
Urgent Care Centers
Current Assets and Liabilities Held for Sale
Gain (loss) on sale of properties					14,000,000
Philadelphia Building
Current Assets and Liabilities Held for Sale
Gain (loss) on sale of properties					$ 2,000,000

ASSETS AND LIABILITIES HELD F_4

ASSETS AND LIABILITIES HELD FOR SALE - Net assets held for sale (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Current liabilities	$ (69)	$ 0
Discontinued Operations, Held-for-sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Accounts receivable	78
Other current assets	25
Investments and other long-term assets	26
Property and equipment	204
Other intangible assets	17
Goodwill	425
Current liabilities	(45)
Long-term liabilities	(24)
Net assets held for sale	$ 706

ASSETS AND LIABILITIES HELD F_5

ASSETS AND LIABILITIES HELD FOR SALE - Significant Components (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Miami-Area Hospitals | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Accumulated other comprehensive loss	$ (3)	$ 10	$ 455
Gain (loss) on sale of properties			406
SC Hospitals | Discontinued Operations, Held-for-sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Accumulated other comprehensive loss	$ 130	$ 127	$ 135

IMPAIRMENT AND RESTRUCTURING _2

IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Impaired Long-Lived Assets Held and Used [Line Items]
Impairment and restructuring charges, and acquisition-related costs	$ 137	$ 226	$ 85
Restructuring charges	79	118	57
Impairment charges	43	94	8
Acquisition costs	15	14	20
Lease termination costs	10	32
Restructuring costs	6	43	24
Acquisition-related transaction costs			20
Hospital Operations
Impaired Long-Lived Assets Held and Used [Line Items]
Impairment charges		88	3
Ambulatory Care
Impaired Long-Lived Assets Held and Used [Line Items]
Impairment charges		6	5
Legal Costs Related to The Sale of Certain Facilities
Impaired Long-Lived Assets Held and Used [Line Items]
Restructuring charges	36
Employee Severance
Impaired Long-Lived Assets Held and Used [Line Items]
Restructuring charges	15	27	14
Global Business Center in Republic of Philippines
Impaired Long-Lived Assets Held and Used [Line Items]
Restructuring charges	$ 12	16	$ 19
Hospital Buildings and Medical Equipment | Hospital Operations
Impaired Long-Lived Assets Held and Used [Line Items]
Impairment charges		82
Buildings Subject To Impairment Charges
Impaired Long-Lived Assets Held and Used [Line Items]
Noncurrent assets		$ 167

LEASES - Balance Sheet Componen

LEASES - Balance Sheet Components (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease assets	$ 1,083	$ 1,129
Finance lease assets	253	303
Total leased assets	1,336	1,432
Operating lease liabilities, current	204	207
Operating lease liabilities, long-term	1,007	1,046
Total operating lease liabilities	1,211	1,253
Finance lease liabilities, current	84	99
Finance lease liabilities, long-term	120	165
Total finance lease liabilities	204	264
Total lease liabilities	$ 1,415	$ 1,517
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Investments and other assets	Investments and other assets
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization	Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Other current liabilities	Other current liabilities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term liabilities	Other long-term liabilities
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Current portion of long-term debt	Current portion of long-term debt
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Long-term debt, net of current portion	Long-term debt, net of current portion

LEASES - Lease Costs (Details)

LEASES - Lease Costs (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating lease expense	$ 259	$ 262	$ 241
Finance lease expense:
Amortization of leased assets	55	58	71
Interest on lease liabilities	8	8	9
Total finance lease expense	63	66	80
Variable and short term-lease expense	159	150	171
Total lease expense	$ 481	$ 478	$ 492
Weighted-average remaining lease term (years), operating leases	7 years 7 months 6 days	8 years	7 years 6 months
Weighted-average remaining lease term (years), finance leases	6 years	5 years 6 months	5 years 8 months 12 days
Weighted-average discount rate, operating leases (percentage)	5%	4.80%	5.10%
Weighted-average discount rate, finance leases (percentage)	6.50%	5.90%	5.40%

LEASES - Supplemental Cash Flow

LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$ 258	$ 250	$ 237
Operating cash outflows from finance leases	13	14	12
Financing cash outflows from finance leases	107	118	140
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	168	341	176
Finance leases	$ 55	$ 97	$ 136

LEASES - Schedule of Lease Matu

LEASES - Schedule of Lease Maturities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Operating Leases
2024	$ 255
2025	225
2026	190
2027	165
2028	136
Later years	494
Total lease payments	1,465
Less: Imputed interest	254
Total operating lease liabilities	1,211	$ 1,253
Less: Current obligations	204	207
Long-term lease obligations	1,007	1,046
Finance Leases
2024	95
2025	54
2026	24
2027	9
2028	7
Later years	70
Total lease payments	259
Less: Imputed interest	55
Total finance lease liabilities	204	264
Less: Current obligations	84	99
Long-term lease obligations	120	165
Total
2024	350
2025	279
2026	214
2027	174
2028	143
Later years	564
Total lease payments	1,724
Less: Imputed interest	309
Total lease liabilities	1,415	$ 1,517
Less: Current obligations	288
Long-term lease obligations	$ 1,127

LEASES - Narrative (Details)

LEASES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022
Lessee, Lease, Description [Line Items]
Operating lease assets		$ 1,083	$ 1,129
Operating lease liability		$ 1,211	$ 1,253
Hospital Operations
Lessee, Lease, Description [Line Items]
Net proceeds from sale of buildings	$ 147
Gain on sale of properties	69
Operating lease assets	103
Operating lease liability	$ 103

LONG-TERM DEBT - Schedule of De

LONG-TERM DEBT - Schedule of Debt (Details) - USD ($) $ in Millions	Dec. 31, 2023	May 31, 2023	Dec. 31, 2022	Jun. 15, 2022
LONG-TERM DEBT AND LEASE OBLIGATIONS
Finance leases, mortgages and other notes	$ 361		$ 453
Unamortized issue costs and note discounts	(121)		(131)
Long-term debt	15,002		15,079
Less: Current portion	120		145
Long-term debt, net of current portion	14,882		14,934
Senior Notes | 6.125% due 2028
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 2,500		2,500
Interest rate, stated percentage	6.125%
Senior Notes | 6.875% due 2031
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 362		362
Interest rate, stated percentage	6.875%
Senior Notes | 4.625% due July 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 0		756
Interest rate, stated percentage	4.625%
Senior Notes | 4.625% due September 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 0		589
Interest rate, stated percentage	4.625%
Senior Notes | 4.875% due 2026
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 2,100		2,100
Interest rate, stated percentage	4.875%
Senior Notes | 5.125% due 2027
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 1,500		1,500
Interest rate, stated percentage	5.125%
Senior Notes | 4.625% due 2028
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 600		600
Interest rate, stated percentage	4.625%
Senior Notes | 4.250% due 2029
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 1,400		1,400
Interest rate, stated percentage	4.25%
Senior Notes | 4.375% due 2030
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 1,450		1,450
Interest rate, stated percentage	4.375%
Senior Notes | 6.125% due 2030
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 2,000		2,000
Interest rate, stated percentage	6.125%			6.125%
Senior Notes | 6.750% due 2031
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 1,350		0
Interest rate, stated percentage	6.75%	6.75%
Senior Notes | 6.250% due 2027
LONG-TERM DEBT AND LEASE OBLIGATIONS
Carrying amount	$ 1,500		$ 1,500
Interest rate, stated percentage	6.25%

LONG-TERM DEBT - Narrative (Det

LONG-TERM DEBT - Narrative (Details)		1 Months Ended	3 Months Ended	6 Months Ended	12 Months Ended
	Feb. 23, 2022 USD ($)	May 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Jun. 30, 2022 USD ($)	Dec. 31, 2023 USD ($) day	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Jun. 15, 2022 USD ($)	Mar. 31, 2022 USD ($)
LONG-TERM DEBT AND LEASE OBLIGATIONS
Loss from early extinguishment of debt					$ (11,000,000)	$ (109,000,000)	$ (74,000,000)
Senior Notes
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount					$ 14,762,000,000
Redemption price percentage					100%
Repurchase obligation due to change of control percentage of principal					101%
Senior Notes | Minimum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Interest rate, stated percentage					4.25%
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage)					5%
Senior Notes | Maximum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Interest rate, stated percentage					6.875%
Secured debt ratio					4
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage)					15%
Senior Notes | 4.625% due September 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Interest rate, stated percentage		4.625%
Redemption price		$ 596,000,000
Principal amount redeemed		$ 589,000,000
Senior Notes | 4.625% due July 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Interest rate, stated percentage		4.625%
Principal amount redeemed									$ 756,000,000
Senior Notes | 7.500% due 2025
LONG-TERM DEBT AND LEASE OBLIGATIONS
Interest rate, stated percentage	7.50%
Repurchased face amount	$ 700,000,000
Debt instrument payment	$ 730,000,000
Senior Notes | 6.125% due 2030
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount										$ 2,000,000,000
Interest rate, stated percentage					6.125%					6.125%
Carrying amount			$ 2,000,000,000		$ 2,000,000,000	2,000,000,000
Senior Notes | 6.750% due 2023
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount				$ 1,748,000,000
Interest rate, stated percentage										6.75%
Repurchased face amount				124,000,000
Debt instrument payment				1,933,000,000
Debt retirement				$ 1,872,000,000
Senior Notes | 4.625% due July 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount			770,000,000			770,000,000
Interest rate, stated percentage					4.625%
Repurchased face amount			14,000,000			14,000,000
Repayments of debt			13,000,000
Carrying amount			756,000,000		$ 0	756,000,000
Senior Notes | 4.625% due September 2024
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount			600,000,000			600,000,000
Interest rate, stated percentage					4.625%
Repurchased face amount			11,000,000			11,000,000
Repayments of debt			11,000,000
Carrying amount			589,000,000		$ 0	589,000,000
Senior Notes | 6.750% due 2031
LONG-TERM DEBT AND LEASE OBLIGATIONS
Aggregate principal amount		$ 1,350,000,000
Interest rate, stated percentage		6.75%			6.75%
Carrying amount			$ 0		$ 1,350,000,000	$ 0
Credit Agreement | Revolving Credit Facility
LONG-TERM DEBT AND LEASE OBLIGATIONS
Revolving credit facility, maximum borrowing capacity (up to)					1,500,000,000						$ 1,500,000,000
Carrying amount					0
Amount available for borrowing under revolving credit facility					1,500,000,000
Threshold limit of revolving credit facility					$ 150,000,000
Threshold limit of unused borrowing availability under the revolving credit facility, number of consecutive days					3 days
Credit Agreement | Revolving Credit Facility | Minimum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Unused commitment fee (percentage)					0.25%
Credit Agreement | Revolving Credit Facility | Maximum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Unused commitment fee (percentage)					0.375%
Credit Agreement | Revolving Credit Facility | Base rate | Minimum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Percentage margin on variable rate (percentage)					0.25%
Credit Agreement | Revolving Credit Facility | Base rate | Maximum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Percentage margin on variable rate (percentage)					0.75%
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
LONG-TERM DEBT AND LEASE OBLIGATIONS
Basis spread on credit spread					0.10%
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Minimum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Percentage margin on variable rate (percentage)					1.25%
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Maximum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Percentage margin on variable rate (percentage)					1.75%
Letter of Credit Facility
LONG-TERM DEBT AND LEASE OBLIGATIONS
Standby letters of credit outstanding					$ 1,000,000
Letter of Credit Facility | Letter Of Credit Facility
LONG-TERM DEBT AND LEASE OBLIGATIONS
Revolving credit facility, maximum borrowing capacity (up to)								$ 200,000,000
Standby letters of credit outstanding					$ 111,000,000
Secured debt to EBITDA ratio					3
Interest rate on issued but undrawn letters of credit (percentage)					1.50%
Issuance fee, based on face amount (percentage)					0.125%
Maximum secured debt covenant ratio					4.25
Letter of Credit Facility | Letter Of Credit Facility | Minimum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Unused commitment fee (percentage)					0.25%
Letter of Credit Facility | Letter Of Credit Facility | Maximum
LONG-TERM DEBT AND LEASE OBLIGATIONS
Unused commitment fee (percentage)					0.375%
Number of business days after notice for reimbursement of drawings | day					3
Letter of Credit Facility | Letter Of Credit Facility | Federal Funds Rate
LONG-TERM DEBT AND LEASE OBLIGATIONS
Percentage margin on variable rate (percentage)					0.50%

LONG-TERM DEBT - Future Maturit

LONG-TERM DEBT - Future Maturities (Details) $ in Millions	Dec. 31, 2023 USD ($)
Long-term debt, including finance lease obligations
Total	$ 15,123
2024	120
2025	92
2026	2,149
2027	3,029
2028	3,114
Later Years	$ 6,619

GUARANTEES (Details)

GUARANTEES (Details) $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Income Guarantee
GUARANTEES
Guarantee obligation period	12 months
Commitment period	3 years
Guarantee of Business Revenue | Minimum
GUARANTEES
Guarantee obligation period	1 year
Guarantee of Business Revenue | Maximum
GUARANTEES
Guarantee obligation period	3 years
Income and Revenue Collection Guarantee
GUARANTEES
Maximum potential amount of future payments under guarantees	$ 356
Income and Revenue Collection Guarantee | Other current liabilities
GUARANTEES
Liability for guarantees	274
Guaranteed Investees of Third Parties
GUARANTEES
Maximum potential amount of future payments under guarantees	88
Guaranteed Investees of Third Parties | Other current liabilities
GUARANTEES
Guarantee obligations for consolidated subsidiaries	$ 21

EMPLOYEE BENEFIT PLANS - Share-

EMPLOYEE BENEFIT PLANS - Share-based Compensation Plans (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation costs, pretax	$ 66	$ 56	$ 56
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for issuance under the plan (in shares)	8,895,000
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period from the date of grant	10 years
Vesting period	3 years
Vesting percentage	33.33%
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual right to receive shares of common stock for a stock based award (in shares)	1
Vesting period	3 years
Vesting percentage	33.33%
Stock-based compensation costs, pretax	$ 46	$ 45	$ 42
Performance Based Restricted Stock Unit | Minimum | Performance-based vesting
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	0%	0%

EMPLOYEE BENEFIT PLANS - Stock

EMPLOYEE BENEFIT PLANS - Stock Options (Details) - Stock Options - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Options
Outstanding at the beginning of the period (in shares)	460,947	520,998	912,531
Exercised (in shares)	(76,507)	(60,051)	(391,533)
Outstanding at the end of the period (in shares)	384,440	460,947	520,998
Wtd. Avg. Exercise Price Per Share
Outstanding at the beginning of the period (in dollars per share)	$ 23.33	$ 23.90	$ 22.51
Exercised (in dollars per share)	26.07	28.26	20.66
Outstanding at the end of the period (in dollars per share)	$ 22.79	$ 23.33	$ 23.90
Aggregate Intrinsic Value
Outstanding at the end of the period	$ 20
Wtd. Avg Remaining Life
Outstanding at the end of the period	4 years 1 month 6 days
Aggregate intrinsic value of awards exercised	$ 4		$ 15
Granted (in shares)	0	0	0

EMPLOYEE BENEFIT PLANS - Range

EMPLOYEE BENEFIT PLANS - Range of Exercise Prices (Details) - Stock Options	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Options Outstanding and Exercisable
Number of options outstanding (in shares) | shares	384,440
Weighted average remaining contractual life	4 years 1 month 6 days
Weighted average exercise price (in dollars per share)	$ 22.79
$18.99 to $20.609
Options Outstanding and Exercisable
Number of options outstanding (in shares) | shares	255,845
Weighted average remaining contractual life	3 years 7 months 6 days
Weighted average exercise price (in dollars per share)	$ 19.62
$18.99 to $20.609 | Minimum
Summary information about outstanding stock options
Lower range of stock exercise price range (in dollars per share)	18.99
$18.99 to $20.609 | Maximum
Summary information about outstanding stock options
Upper range of stock exercise price range (in dollars per share)	$ 20.609
$20.61 to $35.430
Options Outstanding and Exercisable
Number of options outstanding (in shares) | shares	128,595
Weighted average remaining contractual life	5 years 1 month 6 days
Weighted average exercise price (in dollars per share)	$ 29.07
$20.61 to $35.430 | Minimum
Summary information about outstanding stock options
Lower range of stock exercise price range (in dollars per share)	20.61
$20.61 to $35.430 | Maximum
Summary information about outstanding stock options
Upper range of stock exercise price range (in dollars per share)	$ 35.430

EMPLOYEE BENEFIT PLANS - Employ

EMPLOYEE BENEFIT PLANS - Employee Options (Details) - Stock Options	12 Months Ended
	Dec. 31, 2023 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share price (in dollars per share)	$ 75.57
Current Employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based payment award options outstanding percentage	30.80%
Former Employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based payment award options outstanding percentage	69.20%

EMPLOYEE BENEFIT PLANS - Restri

EMPLOYEE BENEFIT PLANS - Restricted Stock Units (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Other Disclosures
Stock-based compensation costs, pretax	$ 66	$ 56	$ 56
Restricted Stock Units
Restricted Stock Units
Unvested at the beginning of the period (in shares)	1,520,418	2,171,202	2,095,206
Granted (in shares)	759,590	641,205	900,018
Vested (in shares)	(954,401)	(1,187,384)	(765,814)
Forfeited (in shares)	(90,445)	(104,605)	(58,208)
Unvested at the end of the period (in shares)	1,421,063	1,520,418	2,171,202
Wtd. Avg. Grant Date Fair Value Per Unit
Unvested at the beginning of the period (in dollars per share)	$ 66.36	$ 40.51	$ 25.87
Granted (in dollars per share)	60.88	80.79	58.61
Vested (in dollars per share)	48.75	37.18	30.51
Forfeited (in dollars per share)	64.61	53.58	37.60
Unvested at the end of the period (in dollars per share)	$ 66.46	$ 66.36	$ 40.51
Other Disclosures
Awards (in shares)	759,590	641,205	900,018
Vesting percentage	33.33%
Stock-based compensation costs, pretax	$ 46	$ 45	$ 42
Unrecognized compensation costs	$ 42
Period for recognition of unrecognized compensation costs	2 years 1 month 6 days
Performance Based Restricted Stock Unit
Restricted Stock Units
Granted (in shares)	185,901
Wtd. Avg. Grant Date Fair Value Per Unit
Granted (in dollars per share)	$ 48.97
Other Disclosures
Awards (in shares)	185,901
Performance Based Restricted Stock Unit | Non Executive Chairman
Restricted Stock Units
Granted (in shares)		53,716
Other Disclosures
Awards (in shares)		53,716
Vesting percentage		100%
Performance Based Restricted Stock Unit | Performance-based vesting | Minimum
Other Disclosures
Vesting percentage	0%	0%
Performance Based Restricted Stock Unit | Performance-based vesting | Maximum
Other Disclosures
Vesting percentage	225%	200%
Time-based RSUs | Vest Ratably Over Quarterly Periods
Restricted Stock Units
Granted (in shares)		53,716
Other Disclosures
Awards (in shares)		53,716
Time-based RSUs | Vest Ratably Over Quarterly Periods | Non Executive Chairman
Restricted Stock Units
Granted (in shares)		53,716	189,215
Other Disclosures
Awards (in shares)		53,716	189,215

EMPLOYEE BENEFIT PLANS - Time-B

EMPLOYEE BENEFIT PLANS - Time-Based RSUs (Details) - Time-based RSUs	12 Months Ended
	Dec. 31, 2023 shares	Dec. 31, 2022 quarter shares	Dec. 31, 2021 quarter shares
Non Employee Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)		7,325
Vest Ratable Over Three Year Period From Grant Date
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	309,282	237,381	263,180
Vesting period	3 years	3 years	3 years
Vest and Settled on Fifth Anniversary
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	42,626
Vest Immediately And Settled On Third Anniversary | Non Employee Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	42,100	35,482	38,366
Vest on December 31, 2023 and Settled on January 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	33,586
Relocation Based Vesting | Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	20,707
Vest and Settled on Third Anniversary
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	2,007		33,351
Vest Ratably Over Quarterly Periods
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)		53,716
Award vesting period, number of quarterly periods | quarter		11	8
Vest Ratably Over Four Year Period From Grant Date
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)		9,215
Vesting period		4 years
Vest And Settle On Third And Fourth Anniversaries
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)		6,170
Vest and Settled on Second Anniversary
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)		4,608
Vest and Settle on Fourth Anniversary
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)			53,341
Vest On December 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)			14,192
Vest And Settled On Second And Fourth Anniversary
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)			8,509
Vest Immediately and Settle Upon Separation From Board | Director
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)			1,372

EMPLOYEE BENEFIT PLANS - Perfor

EMPLOYEE BENEFIT PLANS - Performance-Based RSUs (Details) - Performance Based Restricted Stock Unit - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	185,901
Vesting Over a Three Year Period, 0% to 225%
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	301,562
Vesting Over a Three Year Period, 0% to 225% | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	0%
Vesting Over a Three Year Period, 0% to 225% | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	225%
Performance Based Vesting And Settled Immediately
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	185,901		892
Vesting Over a Three Year Period, 0% to 200%
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)	7,720	287,308	244,259
Vesting Over a Three Year Period, 0% to 200% | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	0%	0%	0%
Vesting Over a Three Year Period, 0% to 200% | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	200%	200%	200%
Vesting on Fourth Anniversary, 0% to 200%
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards (in shares)			53,341
Vesting on Fourth Anniversary, 0% to 200% | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage			0%
Vesting on Fourth Anniversary, 0% to 200% | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage			200%

EMPLOYEE BENEFIT PLANS - Valuat

EMPLOYEE BENEFIT PLANS - Valuation of Restricted Stock Units (Details) - Restricted Stock Units	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected volatility, minimum	53.60%	39.60%	65.20%
Expected volatility , maximum	65.60%	68.10%	79.30%
Risk-free interest rate, minimum	4.20%	1%
Risk-free interest rate, maximum	4.80%	1.70%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate			0.10%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate			0.60%

EMPLOYEE BENEFIT PLANS - USPI M

EMPLOYEE BENEFIT PLANS - USPI Management Equity Plan (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Wtd. Avg. Grant Date Fair Value Per Unit
Stock-based compensation costs, pretax	$ 66	$ 56	$ 56
Payments to noncontrolling interest	$ 167	$ 100	$ 27
Restricted Stock Units
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Contractual right to receive shares of common stock for a stock based award (in shares)	1
Restricted Stock Units
Unvested at the beginning of the period (in shares)	1,520,418	2,171,202	2,095,206
Granted (in shares)	759,590	641,205	900,018
Vested (in shares)	(954,401)	(1,187,384)	(765,814)
Forfeited (in shares)	(90,445)	(104,605)	(58,208)
Unvested at the end of the period (in shares)	1,421,063	1,520,418	2,171,202
Wtd. Avg. Grant Date Fair Value Per Unit
Unvested at the beginning of the period (in dollars per share)	$ 66.36	$ 40.51	$ 25.87
Granted (in dollars per share)	60.88	80.79	58.61
Vested (in dollars per share)	48.75	37.18	30.51
Forfeited (in dollars per share)	64.61	53.58	37.60
Unvested at the end of the period (in dollars per share)	$ 66.46	$ 66.36	$ 40.51
Vesting percentage	33.33%
Stock-based compensation costs, pretax	$ 46	$ 45	$ 42
USPI Management Equity Plan | United Surgical Partners International
Wtd. Avg. Grant Date Fair Value Per Unit
Payments to noncontrolling interest	$ 13	$ 11	$ 9
USPI Management Equity Plan | Restricted Stock Units
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Contractual right to receive shares of common stock for a stock based award (in shares)	1
Restricted Stock Units
Unvested at the beginning of the period (in shares)	922,840	1,494,882	2,025,056
Granted (in shares)	0	0	76,990
Vested (in shares)	(303,171)	(369,691)	(388,588)
Forfeited (in shares)	(11,685)	(202,351)	(218,576)
Unvested at the end of the period (in shares)	607,984	922,840	1,494,882
Wtd. Avg. Grant Date Fair Value Per Unit
Unvested at the beginning of the period (in dollars per share)	$ 34.13	$ 34.13	$ 34.13
Granted (in dollars per share)			34.13
Vested (in dollars per share)	34.13	34.13	34.13
Forfeited (in dollars per share)	34.13	34.13	34.13
Unvested at the end of the period (in dollars per share)	$ 34.13	$ 34.13	$ 34.13
Vested and expected to vest at the end of the period (in shares)	607,984
Stock-based compensation costs, pretax	$ 20	$ 11	$ 13
USPI Management Equity Plan | Restricted Stock Units | Tranche One
Wtd. Avg. Grant Date Fair Value Per Unit
Vesting percentage			20%
USPI Management Equity Plan | Restricted Stock Units | Tranche Two
Wtd. Avg. Grant Date Fair Value Per Unit
Vesting percentage			20%
USPI Management Equity Plan | Restricted Stock Units | Tranche Three
Wtd. Avg. Grant Date Fair Value Per Unit
Vesting percentage			60%
USPI Management Equity Plan | Nonvoting Common Stock
Wtd. Avg. Grant Date Fair Value Per Unit
Outstanding vested shares eligible to be sold (in shares)	51,000

EMPLOYEE BENEFIT PLANS - Empl_2

EMPLOYEE BENEFIT PLANS - Employee Stock Purchase Plan (Details) - Employee Stock Purchase Plan - USD ($) $ / shares in Units, shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized to be issued under the plan (in shares)	4,070
Shares available for issuance under the plan (in shares)	2,501
Percentage of closing price at which shares are purchased by participant	95%
Requisite holding period for shares issued under the plan	1 year
Fair market value per employee per year	$ 25,000
Number of shares (in shares)	69	98	90
Weighted average price (in dollars per share)	$ 65.62	$ 54.19	$ 63.01
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Base earnings elected to be withheld each quarter by eligible employees to purchase shares of the entity's common stock	1%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Base earnings elected to be withheld each quarter by eligible employees to purchase shares of the entity's common stock	10%

EMPLOYEE BENEFIT PLANS - Other

EMPLOYEE BENEFIT PLANS - Other Employee Benefit and Retirement Plans (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Postemployment Benefits [Abstract]
Contribution expense	$ 126	$ 86	$ 98

EMPLOYEE BENEFIT PLANS - Empl_3

EMPLOYEE BENEFIT PLANS - Employee Retirement Plans (Details)	12 Months Ended
	Dec. 31, 2023 USD ($) plan	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Projected benefit obligations
Beginning obligations	$ (1,002,000,000)	$ (1,313,000,000)
Interest cost	(53,000,000)	(37,000,000)	$ (36,000,000)
Actuarial gain (loss)	(15,000,000)	265,000,000
Benefits paid	84,000,000	83,000,000
Annuity purchase	36,000,000	0
Special termination benefit costs	(1,000,000)	0
Ending obligations	(951,000,000)	(1,002,000,000)	(1,313,000,000)
Fair value of plans assets
Beginning plan assets	648,000,000	867,000,000
Gain (loss) on plan assets	41,000,000	(161,000,000)
Employer contribution	0	2,000,000
Benefits paid	(61,000,000)	(60,000,000)
Annuity purchase	(36,000,000)	0
Ending plan assets	592,000,000	648,000,000	867,000,000
Funded status of plans	(359,000,000)	(354,000,000)
Accumulated benefit obligation	951,000,000	1,002,000,000
Amounts recognized in the Consolidated Balance Sheets consist of:
Other current liability	(24,000,000)	(23,000,000)
Other long-term liability	(335,000,000)	(331,000,000)
Accumulated other comprehensive loss	224,000,000	222,000,000
Components of net periodic benefit costs
Interest costs	53,000,000	37,000,000	36,000,000
Expected return on plan assets	(36,000,000)	(42,000,000)	(53,000,000)
Amortization of net actuarial loss	7,000,000	9,000,000	11,000,000
Special termination benefit costs	1,000,000	0	0
Net periodic benefit cost (income)	$ 25,000,000	$ 4,000,000	$ (6,000,000)
Defined Benefit Plan Net Periodic Benefit Cost Credit Interest Cost Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag	Interest costs	Interest costs	Interest costs
Defined Benefit Plan Net Periodic Benefit Cost Credit Expected Return Loss Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag	Expected return on plan assets	Expected return on plan assets	Expected return on plan assets
Net Periodic Benefit Costs Assumptions:
Gain (loss) adjustments recorded in other comprehensive income (loss)	$ (2,000,000)	$ 72,000,000	$ 61,000,000
Net actuarial losses	(9,000,000)	63,000,000	50,000,000
Amortization of net actuarial loss	(7,000,000)	(9,000,000)	(11,000,000)
Cumulative net actuarial losses	224,000,000	222,000,000	294,000,000
Unrecognized prior service costs	$ 0	$ 0	$ 0
SERP
Employee Retirement Plans
Number of frozen plans | plan	3
Accumulated Benefit Obligations Assumptions
Discount rate	5.50%	5.75%
Compensation increase rate	3%	3%
Net Periodic Benefit Costs Assumptions:
Discount rate	5.75%	3%	2.75%
Compensation increase rate	3%	3%	3%
Pension Plan
Fair value of plans assets
Beginning plan assets	$ 648,000,000
Ending plan assets	$ 592,000,000	$ 648,000,000
Accumulated Benefit Obligations Assumptions
Discount rate	5.25%	5.51%
Net Periodic Benefit Costs Assumptions:
Discount rate	5.51%	2.89%	2.53%
Long-term rate of return on assets	5.75%	5%	6.25%

EMPLOYEE BENEFIT PLANS - Asset

EMPLOYEE BENEFIT PLANS - Asset Allocations (Details) - Pension Plan	Dec. 31, 2023
Cash and cash equivalents
Weighted-average asset allocations by asset category
Target	0%
Actual	1%
Equity securities
Weighted-average asset allocations by asset category
Target	20%
Actual	6%
Debt securities
Weighted-average asset allocations by asset category
Target	73%
Actual	75%
Alternative investments
Weighted-average asset allocations by asset category
Target	7%
Actual	18%

EMPLOYEE BENEFIT PLANS - Fair V

EMPLOYEE BENEFIT PLANS - Fair Value of Assets and Future Benefit Payments (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Employee Retirement Plans
Fair value of DMC Pension Plan assets	$ 592	$ 648	$ 867
SERP and DMC Pension Plan
Total	789
2024	84
2025	84
2026	83
2027	82
2028	81
Five Years Thereafter	375
Amounts recognized in the Consolidated Balance Sheets consist of:
Benefit plan obligations	(359)	(354)
Other current liability	24	23
Defined benefit plan obligations	335	331
Expected contribution to the plan for 2023	24
Pension Plan
Employee Retirement Plans
Fair value of DMC Pension Plan assets	592	648
Pension Plan | Cash and cash equivalents
Employee Retirement Plans
Fair value of DMC Pension Plan assets	6	7
Pension Plan | Equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	39	89
Pension Plan | Fixed income funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	442
Pension Plan | U.S. government obligations
Employee Retirement Plans
Fair value of DMC Pension Plan assets		200
Pension Plan | Corporate debt securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets		249
Pension Plan | Private equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	97	78
Pension Plan | Hedge funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	8	25
Pension Plan | Level 1
Employee Retirement Plans
Fair value of DMC Pension Plan assets	487	545
Pension Plan | Level 1 | Cash and cash equivalents
Employee Retirement Plans
Fair value of DMC Pension Plan assets	6	7
Pension Plan | Level 1 | Equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	39	89
Pension Plan | Level 1 | Fixed income funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	442
Pension Plan | Level 1 | U.S. government obligations
Employee Retirement Plans
Fair value of DMC Pension Plan assets		200
Pension Plan | Level 1 | Corporate debt securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets		249
Pension Plan | Level 1 | Private equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 1 | Hedge funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 2
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 2 | Cash and cash equivalents
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 2 | Equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 2 | Fixed income funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0
Pension Plan | Level 2 | U.S. government obligations
Employee Retirement Plans
Fair value of DMC Pension Plan assets		0
Pension Plan | Level 2 | Corporate debt securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets		0
Pension Plan | Level 2 | Private equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 2 | Hedge funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 3
Employee Retirement Plans
Fair value of DMC Pension Plan assets	105	103
Pension Plan | Level 3 | Cash and cash equivalents
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 3 | Equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0	0
Pension Plan | Level 3 | Fixed income funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	0
Pension Plan | Level 3 | U.S. government obligations
Employee Retirement Plans
Fair value of DMC Pension Plan assets		0
Pension Plan | Level 3 | Corporate debt securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets		0
Pension Plan | Level 3 | Private equity securities
Employee Retirement Plans
Fair value of DMC Pension Plan assets	97	78
Pension Plan | Level 3 | Hedge funds
Employee Retirement Plans
Fair value of DMC Pension Plan assets	$ 8	$ 25

PROPERTY AND EQUIPMENT - Compon

PROPERTY AND EQUIPMENT - Components (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Components of property and equipment
Finance lease assets	$ 378	$ 413
Total property, plant and equipment, gross	12,714	12,663
Accumulated depreciation and amortization	(6,478)	(6,201)
Net property and equipment	6,236	6,462
Depreciation	696	669	$ 667
Land
Components of property and equipment
Property plant and equipment gross	625	661
Buildings and improvements
Components of property and equipment
Property plant and equipment gross	6,692	6,646
Construction in progress
Components of property and equipment
Property plant and equipment gross	269	195
Equipment
Components of property and equipment
Property plant and equipment gross	$ 4,750	$ 4,748

GOODWILL AND OTHER INTANGIBLE_3

GOODWILL AND OTHER INTANGIBLE ASSETS - Goodwill (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Changes in the carrying amount of goodwill
Goodwill at beginning of period, net of accumulated impairment losses	$ 10,123,000,000
Goodwill at end of period, net of accumulated impairment losses	10,307,000,000	$ 10,123,000,000
Hospital Operations
Changes in the carrying amount of goodwill
Goodwill at beginning of period, net of accumulated impairment losses	3,411,000,000	3,413,000,000
Goodwill acquired during the year and purchase price allocation adjustments	133,000,000	1,000,000
Goodwill related to assets held for sale and disposed	(425,000,000)	(3,000,000)
Goodwill at end of period, net of accumulated impairment losses	3,119,000,000	3,411,000,000
Accumulated impairment losses	2,430,000,000	2,430,000,000
Ambulatory Care
Changes in the carrying amount of goodwill
Goodwill at beginning of period, net of accumulated impairment losses	6,712,000,000	5,848,000,000
Goodwill acquired during the year and purchase price allocation adjustments	493,000,000	866,000,000
Goodwill related to assets held for sale and disposed	(17,000,000)	(2,000,000)
Goodwill at end of period, net of accumulated impairment losses	7,188,000,000	6,712,000,000
Accumulated impairment losses	$ 0	$ 0

GOODWILL AND OTHER INTANGIBLE_4

GOODWILL AND OTHER INTANGIBLE ASSETS - Other Intangible Assets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Net [Abstract]
Gross Carrying Amount	$ 2,097	$ 2,138
Accumulated Amortization	(1,447)	(1,428)
Total	650	710
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Total other intangible assets with indefinite lives	718	714
Gross Carrying Amount	2,815	2,852
Net Book Value	1,368	1,424
Trade names
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Total other intangible assets with indefinite lives	105	105
Contracts
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Total other intangible assets with indefinite lives	609	603
Other Intangible Assets
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Total other intangible assets with indefinite lives	4	6
Capitalized software costs
Finite-Lived Intangible Assets, Net [Abstract]
Gross Carrying Amount	1,712	1,751
Accumulated Amortization	(1,205)	(1,206)
Total	507	545
Contracts
Finite-Lived Intangible Assets, Net [Abstract]
Gross Carrying Amount	294	295
Accumulated Amortization	(164)	(146)
Total	130	149
Other Intangible Assets
Finite-Lived Intangible Assets, Net [Abstract]
Gross Carrying Amount	91	92
Accumulated Amortization	(78)	(76)
Total	$ 13	$ 16

GOODWILL AND OTHER INTANGIBLE_5

GOODWILL AND OTHER INTANGIBLE ASSETS - Amortization (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Estimated future amortization of intangibles with finite useful lives
Total	$ 650	$ 710
2024	132
2025	124
2026	99
2027	84
2028	61
Later Years	150
Amortization expense	$ 174	$ 172	$ 188

OTHER ASSETS - Schedule of Othe

OTHER ASSETS - Schedule of Other Current Assets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Accounts receivable and allowance for doubtful accounts
Prepaid expenses	$ 391	$ 400
Contract assets	208	200
California provider fee program receivables	2,914	2,943
Receivables from other government programs	282	187
Guarantees	274	143
Non-patient receivables	260	390
Other	95	88
Total other current assets	1,839	1,775
California's Provider Fee Program
Accounts receivable and allowance for doubtful accounts
California provider fee program receivables	329	367
Total other current assets	$ 329	$ 367

OTHER ASSETS - Schedule of Inve

OTHER ASSETS - Schedule of Investments and Other Assets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Investments and other assets
Marketable securities	$ 48	$ 30
Equity investments in unconsolidated healthcare entities	1,512	1,599
Total investments	1,560	1,629
Cash surrender value of life insurance policies	43	37
Long-term deposits	50	56
California provider fee program receivables	334	197
Operating lease assets	1,083	1,129
Other long-term receivables and other assets	87	99
Total investments and other assets	$ 3,157	$ 3,147

ACCUMULATED OTHER COMPREHENSI_3

ACCUMULATED OTHER COMPREHENSIVE LOSS - Accumulated Other Comprehensive Loss (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ 1,608	$ 1,142
Adjustments for defined benefit plans
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(180)	(178)
Unrealized gains on investments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(1)	(3)
Accumulated Other Comprehensive Loss
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (181)	$ (181)

ACCUMULATED OTHER COMPREHENSI_4

ACCUMULATED OTHER COMPREHENSIVE LOSS - Income Tax Expense (Benefit) (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Adjustments for defined benefit plans	$ 0	$ 18
Foreign currency translation adjustments and other	0	(1)
Net income tax expense related to items of other comprehensive income	$ 0	$ 17	$ 14

NET OPERATING REVENUES - Net Op

NET OPERATING REVENUES - Net Operating Revenue By Source (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 20,548	$ 19,174	$ 19,485
Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	3,865	3,248	2,718
Operating Segments | Hospital Operations
Disaggregation of Revenue [Line Items]
Net operating revenues	16,683	15,926	16,767
Operating Segments | Hospital Operations | Other Revenues
Disaggregation of Revenue [Line Items]
Net operating revenues	2,133	2,079	2,008
Operating Segments | Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	3,865	3,248	2,718
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Total
Disaggregation of Revenue [Line Items]
Net operating revenues	14,550	13,847	14,759
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Medicare
Disaggregation of Revenue [Line Items]
Net operating revenues	2,383	2,369	2,615
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Medicaid
Disaggregation of Revenue [Line Items]
Net operating revenues	1,233	1,069	1,254
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Managed care
Disaggregation of Revenue [Line Items]
Net operating revenues	10,248	9,607	9,985
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Uninsured
Disaggregation of Revenue [Line Items]
Net operating revenues	96	141	199
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Indemnity and other
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 590	$ 661	$ 706

NET OPERATING REVENUES - Narrat

NET OPERATING REVENUES - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Reimbursement program assessments	$ 126	$ 123
Net operating revenues	20,548	19,174	$ 19,485
Revision of Prior Period, Adjustment
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 24	$ 10	$ 26

NET OPERATING REVENUES - Net _2

NET OPERATING REVENUES - Net Operating Revenue Composition, Ambulatory Segment (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 20,548	$ 19,174	$ 19,485
Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	3,865	3,248	2,718
Net patient service revenues | Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	3,713	3,115	2,604
Management fees | Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	123	110	86
Revenue from other sources | Ambulatory Care
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 29	$ 23	$ 28

NET OPERATING REVENUES - Perfor

NET OPERATING REVENUES - Performance Obligation (Details) - Hospital Operations $ in Millions	Dec. 31, 2023 USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 6,026
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 685
Revenue, remaining performance obligation, expected timing of satisfaction, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 684
Revenue, remaining performance obligation, expected timing of satisfaction, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, remaining performance obligation, amount	$ 2,608
Revenue, remaining performance obligation, expected timing of satisfaction, period

INSURANCE - Property Insurance

INSURANCE - Property Insurance (Details) - USD ($) $ in Millions	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Insurance coverage
Insurance recoveries		$ 41	$ 14
Net operating revenues		20,548	19,174	$ 19,485
Forecast
Insurance coverage
Insurance, annual coverage limit	$ 850
Insurance Recoveries
Insurance coverage
Net operating revenues		$ 34	$ 6
Floods | Forecast
Insurance coverage
Insurance, maximum coverage per incident	100
Earthquakes | Forecast | Other Geographic Areas
Insurance coverage
Insurance, maximum coverage per incident	200
Earthquakes | Forecast | CALIFORNIA
Insurance coverage
Insurance, maximum coverage per incident	200
Windstorms | Forecast
Insurance coverage
Insurance, maximum coverage per incident	200
Fires and Other Perils | Forecast
Insurance coverage
Insurance, maximum coverage per incident	$ 850
New Madrid Fault Earthquakes | Forecast
Insurance coverage
Insurance deductible as a percent	2%
Insurance, maximum deductible per incident	$ 25
Fires and Certain Other Covered Losses | Forecast
Insurance coverage
Insurance, deductible	$ 5
California Earthquakes And Named Windstorms | Forecast
Insurance coverage
Insurance deductible as a percent	5%

INSURANCE - Professional and Ge

INSURANCE - Professional and General Liability Reserves (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Insurance coverage
Malpractice expense, portion related to adverse developments in prior years	$ 116	$ 74	$ 131
Other Operating Expense, Net
Insurance coverage
Malpractice expense	369	276	$ 355
Professional and General Liability Reserves
Insurance coverage
Self insurance reserve	$ 1,046	$ 1,045

CLAIMS AND LAWSUITS - Reconcili

CLAIMS AND LAWSUITS - Reconciliations (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Loss Contingency Accrual [Roll Forward]
Litigation and investigation costs	$ 47	$ 70	$ 116
Claims, Lawsuits, and Regulatory Proceedings
Loss Contingency Accrual [Roll Forward]
Litigation reserve, Balances at Beginning of Period	51	78	26
Litigation and investigation costs	47	70	116
Cash Payments	(59)	(100)	(59)
Other	1	3	(5)
Litigation reserve, Balances at End of Period	$ 40	$ 51	$ 78

REDEEMABLE NONCONTROLLING INT_3

REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Narrative (Details) - USD ($) $ in Millions	1 Months Ended	12 Months Ended
	Jun. 30, 2022	Dec. 31, 2023	Dec. 31, 2022
Interests acquired and other disclosures
Other current liabilities		$ 1,779	$ 1,581
Other long-term liabilities		1,709	1,800
United Surgical Partners International
Interests acquired and other disclosures
Purchase and sales of business and noncontrolling interest, net	$ 365
Loss from purchase of noncontrolling interests	23
Other current liabilities		135	135
Other long-term liabilities		63	$ 190
Baylor University Medical Center | United Surgical Partners International
Interests acquired and other disclosures
Share purchase agreement amount of payment	406
Share purchase agreement, payment for execution	$ 11
Share purchase agreement, monthly payment		$ 11
Baylor University Medical Center | United Surgical Partners International | Put Option
Interests acquired and other disclosures
Joint venture ownership (as a percentage)	5%

REDEEMABLE NONCONTROLLING INT_4

REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Changes in Redeemable Noncontrolling Interests (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]
Balances at beginning of period	$ 2,149
Net income	366	$ 348	$ 336
Distributions paid to noncontrolling interests	(289)	(229)	(206)
Balances at end of period	2,391	2,149
Redeemable Noncontrolling Interests
Increase (Decrease) in Temporary Equity [Roll Forward]
Balances at beginning of period	2,149	2,203
Net income	366	348
Distributions paid to noncontrolling interests	(305)	(331)
Accretion of redeemable noncontrolling interests	0	104
Purchases and sales of businesses and noncontrolling interests, net	181	(175)
Balances at end of period	$ 2,391	$ 2,149	$ 2,203

REDEEMABLE NONCONTROLLING INT_5

REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Segment Details (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]
Redeemable noncontrolling interests	$ 2,391	$ 2,149
Net income available to redeemable noncontrolling interests	366	348	$ 336
Hospital Operations
Increase (Decrease) in Temporary Equity [Roll Forward]
Redeemable noncontrolling interests	860	792
Net income available to redeemable noncontrolling interests	84	100	93
Ambulatory Care
Increase (Decrease) in Temporary Equity [Roll Forward]
Redeemable noncontrolling interests	1,531	1,357
Net income available to redeemable noncontrolling interests	$ 282	$ 248	$ 243

INCOME TAXES - Provision and De

INCOME TAXES - Provision and Deferred Taxes (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current tax expense:
Federal	$ 208	$ 78	$ 50
State	46	57	111
Total	254	135	161
Deferred tax expense (benefit):
Federal	55	174	267
State	(3)	35	(17)
Total	52	209	250
Income tax expense	$ 306	$ 344	$ 411

INCOME TAXES - Federal Tax Reco

INCOME TAXES - Federal Tax Reconciliation (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Foreign pretax loss	$ 3	$ 8	$ 5
Reconciliation between reported income tax expense (benefit) and income taxes calculated by the statutory federal income tax rate
Tax expense at statutory federal rate of 21%	340	282	396
State income taxes, net of federal income tax benefit	70	64	77
Tax benefit attributable to noncontrolling interests	(147)	(122)	(114)
Nondeductible goodwill	0	1	35
Nondeductible executive compensation	6	10	8
Impact of change in state filing method, net of change in unrecognized tax benefit	(20)	0	0
Nondeductible litigation costs	0	0	1
Stock-based compensation tax benefit	(2)	(6)	(5)
Changes in valuation allowance	71	120	2
Prior-year provision to return adjustments and other changes in deferred taxes	(9)	(12)	8
Other items	(3)	7	3
Income tax expense	$ 306	$ 344	$ 411

INCOME TAXES - Components of De

INCOME TAXES - Components of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Assets
Reserves related to discontinued operations and restructuring charges	$ 6	$ 5
Receivables (doubtful accounts and adjustments)	222	246
Medicare advance payments	0	0
Accruals for retained insurance risks	232	227
Other long-term liabilities	32	27
Benefit plans	233	207
Other accrued liabilities	20	30
Interest expense limitation	206	133
Net operating loss carryforwards	71	74
Stock-based compensation	13	13
Right-of-use lease assets and obligations	129	192
Other items	4	11
Deferred tax assets, gross	1,168	1,165
Valuation allowance	(248)	(177)	$ (57)
Deferred tax assets, net	920	988
Liabilities
Depreciation and fixed-asset differences	430	436
Intangible assets	429	416
Investments and other assets	119	112
Right-of-use lease assets and obligations	111	173
Other items	80	49
Deferred tax liabilities, gross, total	1,169	1,186
Deferred tax liabilities, total	1,169	1,186
Reconciliation of the deferred tax assets and liabilities
Deferred income tax assets	77	19
Deferred tax liabilities	(326)	(217)
Net deferred tax liability	$ (249)	$ (198)

INCOME TAXES - Valuation Allowa

INCOME TAXES - Valuation Allowances and Unrecognized Tax Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
INCOME TAXES
Increase (decrease) in valuation allowance against deferred tax assets	$ 71	$ 120	$ 2
Increase (decrease) in valuation allowance due to limitations on deductions of interest expense	73	123	2
Increase (decrease) in valuation allowance due to changes based on expiration or worthlessness of unutilized state net operating loss carryovers	(2)	(1)	(2)
Increase (decrease) in valuation allowance due to changes in expected realizability of deferred tax assets		(2)	2
Valuation allowance	248	177	57
Changes in unrecognized tax benefits
Beginning balance	34	34
Ending balance		34	34
Unrecognized tax benefits which, if recognized, would impact effective tax rate	63	32	32
Unrecognized tax benefits, period increase (decrease)	24		3
Total accrued interest and penalties on unrecognized tax benefits	2
Continuing Operations
Changes in unrecognized tax benefits
Beginning balance	34	34	31
Reductions due to a lapse of statute of limitations	(1)	0	(3)
Increases due to tax positions taken in prior periods	31
Ending balance	$ 64	$ 34	$ 34

INCOME TAXES - NOL and Tax Cred

INCOME TAXES - NOL and Tax Credit Carryforwards (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
Operating loss carryforwards
Unrecognized federal and state tax benefits and reserves for interest and penalties, which may decrease in the next 12 months	$ 0
Charitable contribution carryforwards	52,000,000
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards	71,000,000	$ 74,000,000
Federal
Operating loss carryforwards
Net operating loss carryforwards	41,000,000
Operating loss carryforwards, subject to expiration	39,000,000
Operating loss carryforwards, not subject to expiration	2,000,000
State
Operating loss carryforwards
Operating loss carryforwards, subject to expiration	3,339,000,000
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards	$ 35,000,000

EARNINGS PER COMMON SHARE (Deta

EARNINGS PER COMMON SHARE (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Net Income Available to Common Shareholders (Numerator)
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share	$ 611	$ 410	$ 915
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock	(13)	8	0
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share	$ 598	$ 418	$ 915
Weighted Average Shares (Denominator)
Net income available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in shares)	101,639	106,929	106,833
Effect of dilutive stock options, restricted stock units and deferred compensation units (in shares)	3,161	3,587	1,738
Net income available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in shares)	104,800	110,516	108,571
Per-Share Amount
Net income available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in dollars per share)	$ 6.01	$ 3.83	$ 8.56
Effect of dilutive stock options, restricted stock units, and deferred compensation units (in dollars per share)	(0.30)	(0.05)	(0.13)
Net income available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in dollars per share)	$ 5.71	$ 3.78	$ 8.43

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 43	$ 94	$ 8
Fair Value, Nonrecurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-lived assets held for sale	775
Long-lived assets held and used		167
Fair Value, Nonrecurring | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-lived assets held for sale	0
Long-lived assets held and used		0
Fair Value, Nonrecurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-lived assets held for sale	775
Long-lived assets held and used		167
Fair Value, Nonrecurring | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-lived assets held for sale	$ 0
Long-lived assets held and used		$ 0
Fair Value, Recurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Estimated fair value of the long-term debt instrument as a percentage of carrying value	96.90%	92.80%

ACQUISITIONS - Narrative (Detai

ACQUISITIONS - Narrative (Details)	1 Months Ended			12 Months Ended
	Dec. 31, 2023 USD ($) healthcare_facility	Jul. 31, 2022 USD ($) surgery_center	Dec. 31, 2021 USD ($) surgery_center	Dec. 31, 2023 USD ($) surgery_center hospital	Dec. 31, 2022 USD ($) surgery_center	Dec. 31, 2021 USD ($) hospital quarter business
Business Acquisition [Line Items]
Goodwill	$ 10,307,000,000			$ 10,307,000,000	$ 10,123,000,000
Goodwill, purchase accounting adjustments				(18,000,000)
Acquisition-related transaction costs						$ 20,000,000
Ambulatory Care
Business Acquisition [Line Items]
Goodwill	$ 7,188,000,000		$ 5,848,000,000	$ 7,188,000,000	6,712,000,000	5,848,000,000
NextCare Arizona I JC, LLC
Business Acquisition [Line Items]
Business acquisition, percentage of voting interests acquired	55%			55%
Number of operational urgent care centers acquired | healthcare_facility	41
Cash paid to acquire businesses	$ 75,000,000
Business combination, contingent consideration, liability	10,000,000			$ 10,000,000
Goodwill	133,000,000			133,000,000
2023 Acquisition | Ambulatory Care
Business Acquisition [Line Items]
Consideration conveyed in the acquisition				$ 149,000,000
Number of surgical centers acquired | surgery_center				20
Number of ambulatory surgery centers noncontrolling interests | surgery_center				11
Series of Individual Business Acquisitions
Business Acquisition [Line Items]
Goodwill	644,000,000		664,000,000	$ 644,000,000	860,000,000	664,000,000
Business combination acquisition noncontrolling interest, fair value	$ 102,000,000		$ 95,000,000	102,000,000	273,000,000	95,000,000
Acquisition-related transaction costs				15,000,000	14,000,000
Gains on consolidations				$ 16,000,000	0	23,000,000
Series of Individual Business Acquisitions | Ambulatory Care
Business Acquisition [Line Items]
Cash paid to acquire businesses					65,000,000	21,000,000
Consideration conveyed in the acquisition					$ 65,000,000	$ 74,000,000
Number of surgical centers acquired					11	2
Number of ambulatory surgery centers noncontrolling interests | surgery_center					23
Number of business acquisitions | business						11
Number of hospitals | hospital						3
United Urology Group
Business Acquisition [Line Items]
Number of ambulatory surgery centers operated by subsidiaries | surgery_center		19
United Urology Group | 2022 Acquisition | Ambulatory Care
Business Acquisition [Line Items]
Cash paid to acquire businesses		$ 104,000,000
Goodwill		$ 316,000,000
Number of ambulatory surgery centers development stage | surgery_center		3
Business combination acquisition noncontrolling interest, fair value		$ 223,000,000
United Surgical Partners International | Ambulatory Care
Business Acquisition [Line Items]
Number of ambulatory surgery centers | hospital				461
United Surgical Partners International | 2021 SCD Centers | Ambulatory Care
Business Acquisition [Line Items]
Number of surgical centers acquired | surgery_center			86
Surgical Center Development | 2021 SCD Centers | Ambulatory Care
Business Acquisition [Line Items]
Cash paid to acquire businesses						$ 1,125,000,000
Number of ambulatory surgery centers development stage | surgery_center			14
Number of ambulatory surgery centers noncontrolling interests | surgery_center			57
Number of ambulatory surgery centers | surgery_center			15

ACQUISITIONS - Purchase Price A

ACQUISITIONS - Purchase Price Allocation (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Final purchase price allocations
Goodwill	$ 10,307,000,000	$ 10,123,000,000
Cash paid, net of cash acquired	(224,000,000)	(234,000,000)	$ (1,220,000,000)
Series of Individual Business Acquisitions
Final purchase price allocations
Current assets	34,000,000	38,000,000	59,000,000
Property and equipment	28,000,000	54,000,000	88,000,000
Other intangible assets	5,000,000	2,000,000	8,000,000
Goodwill	644,000,000	860,000,000	664,000,000
Other long-term assets	32,000,000	99,000,000	796,000,000
Previously held equity method investments	(99,000,000)	(207,000,000)	(43,000,000)
Current liabilities	(36,000,000)	(41,000,000)	(25,000,000)
Long-term liabilities	(37,000,000)	(118,000,000)	(70,000,000)
Redeemable noncontrolling interests in equity of consolidated subsidiaries	(229,000,000)	(180,000,000)	(139,000,000)
Noncontrolling interests	(102,000,000)	(273,000,000)	(95,000,000)
Cash paid, net of cash acquired	(224,000,000)	(234,000,000)	(1,220,000,000)
Gains on consolidations	$ 16,000,000	$ 0	$ 23,000,000

SEGMENT INFORMATION - Narrative

SEGMENT INFORMATION - Narrative (Details) $ in Millions	1 Months Ended			3 Months Ended	12 Months Ended
	Dec. 31, 2023 healthcare_facility state	Jun. 30, 2022 USD ($)	Apr. 30, 2021 quarter	Mar. 31, 2021	Dec. 31, 2023 state hospital surgery_center healthcare_facility segment	Dec. 31, 2022 segment	Jun. 29, 2022	Apr. 01, 2021 imaging_center
Concentration Risk [Line Items]
Number of reportable segments | segment					2	3
NextCare Arizona I JC, LLC
Concentration Risk [Line Items]
Number of operational urgent care centers acquired | healthcare_facility	41
NextCare Arizona II JC, LLC
Concentration Risk [Line Items]
Number of operational urgent care centers acquired, noncontrolling interest | healthcare_facility	15
Baylor University Medical Center | United Surgical Partners International
Concentration Risk [Line Items]
Share purchase agreement amount of payment | $		$ 406
Hospital Operations
Concentration Risk [Line Items]
Number of hospitals owned by subsidiaries					61
Number of states in which entity operates | state	9				9
Number of outpatient facilities operated | healthcare_facility					164
Number of imaging centers transferred | imaging_center								24
Hospital Operations | United Surgical Partners International
Concentration Risk [Line Items]
Percentage of assets transferred between segments				1%
Ambulatory Care
Concentration Risk [Line Items]
Number of urgent care centers sold | quarter			40
Ambulatory Care | United Surgical Partners International
Concentration Risk [Line Items]
Ownership percentage of subsidiary		100%					95%
Ambulatory Care | United Surgical Partners International
Concentration Risk [Line Items]
Number of states in which entity operates | state	35				35
Number of ambulatory surgery centers					461
Number of ambulatory surgery centers consolidated | surgery_center					322
Number of surgical hospitals operated by subsidiaries					24
Number of surgical hospitals consolidated					8

SEGMENT INFORMATION - Reconcili

SEGMENT INFORMATION - Reconciling Items (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Assets	$ 28,312	$ 27,156	$ 27,579
Capital expenditures	751	762	658
Net operating revenues	20,548	19,174	19,485
Equity in earnings of unconsolidated affiliates	228	216	218
Adjusted EBITDA	3,541	3,469	3,483
Depreciation and amortization	870	841	855
Adjusted Segment EBITDA [Abstract]
Adjusted EBITDA	3,541	3,469	3,483
Loss from divested and closed businesses	0	0	(1)
Depreciation and amortization	(870)	(841)	(855)
Impairment and restructuring charges, and acquisition-related costs	(137)	(226)	(85)
Litigation and investigation costs	(47)	(70)	(116)
Interest expense	(901)	(890)	(923)
Loss from early extinguishment of debt	(11)	(109)	(74)
Other non-operating income, net	19	10	14
Gains on sales, consolidation and deconsolidation of facilities	23	1	445
Income from continuing operations, before income taxes	1,617	1,344	1,888
Hospital Operations
Segment Reporting Information [Line Items]
Assets	17,268	16,599	18,106
Capital expenditures	671	687	592
Equity in earnings of unconsolidated affiliates	10	10	25
Adjusted EBITDA	1,997	2,142	2,286
Depreciation and amortization	750	729	760
Adjusted Segment EBITDA [Abstract]
Adjusted EBITDA	1,997	2,142	2,286
Depreciation and amortization	(750)	(729)	(760)
Hospital Operations | Operating segments
Segment Reporting Information [Line Items]
Net operating revenues	16,683	15,926	16,767
Ambulatory Care
Segment Reporting Information [Line Items]
Assets	11,044	10,557	9,473
Capital expenditures	80	75	66
Net operating revenues	3,865	3,248	2,718
Equity in earnings of unconsolidated affiliates	218	206	193
Adjusted EBITDA	1,544	1,327	1,197
Depreciation and amortization	120	112	95
Adjusted Segment EBITDA [Abstract]
Adjusted EBITDA	1,544	1,327	1,197
Depreciation and amortization	(120)	(112)	(95)
Ambulatory Care | Operating segments
Segment Reporting Information [Line Items]
Net operating revenues	$ 3,865	$ 3,248	$ 2,718

SCHEDULE II-VALUATION AND QUA_2

SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS (Details) - Valuation allowance for deferred tax assets - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Movement in valuation and qualifying accounts
Balance at Beginning of Period	$ 177	$ 57	$ 55
Costs and Expenses	71	120	2
Deductions	0	0	0
Other Items	0	0	0
Balance at End of Period	$ 248	$ 177	$ 57