0000950170-24-018021 | 10-K | XBRL Viewer | Community Health Systems INC

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Long-Term Debt - Schedule of Debt (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt and lease obligations	$ 11,487	$ 11,635
Less: Unamortized deferred debt issuance costs and note discount	(338)	(402)
Less: Current maturities	(21)	(21)
Total long-term debt	11,466	11,614
ABL Facility
Debt Instrument [Line Items]
Debt and lease obligations	247	53
Senior Notes \| Senior Notes at 6.875%, Due 2028
Debt Instrument [Line Items]
Debt and lease obligations	756	756
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt and lease obligations	1,116	2,101
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2027
Debt Instrument [Line Items]
Debt and lease obligations	700	700
Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Debt Instrument [Line Items]
Debt and lease obligations	1,900	1,900
Senior Secured Notes \| Senior Secured Notes at 6%, Due 2029
Debt Instrument [Line Items]
Debt and lease obligations	644	900
Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Debt Instrument [Line Items]
Debt and lease obligations	1,535	1,535
Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Debt Instrument [Line Items]
Debt and lease obligations	1,058	1,058
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032
Debt Instrument [Line Items]
Debt and lease obligations	1,000
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875%, Due 2029
Debt Instrument [Line Items]
Debt and lease obligations	1,244	1,386
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125%, Due 2030
Debt Instrument [Line Items]
Debt and lease obligations	1,227	1,232
Finance Lease and Financing Obligations
Debt Instrument [Line Items]
Debt and lease obligations	366	380
Other
Debt Instrument [Line Items]
Debt and lease obligations	$ 32	$ 36

Basis of Presentation and Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Accounting

Business. Community Health Systems, Inc. is a holding company and operates no business in its own name. On a consolidated basis, Community Health Systems, Inc. and its subsidiaries (collectively the “Company”) own, lease and operate general acute care hospitals as well as outpatient facilities in communities across the country. As of December 31, 2023, the Company’s subsidiaries own or lease 71 affiliated hospitals, with approximately 12,000 beds, and operate more than 1,000 sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Throughout these notes to the consolidated financial statements, Community Health Systems, Inc. (the “Parent Company”) and its consolidated subsidiaries are referred to on a collective basis as the “Company.” This drafting style is not meant to indicate that the publicly-traded Parent Company or any particular subsidiary of the Parent Company owns or operates any asset, business, or property. The hospitals, operations and businesses described in this filing are owned and operated, and management services provided, by distinct and indirect subsidiaries of Community Health Systems, Inc.

As of December 31, 2023, Indiana, Alabama, Texas and Florida represent the only areas of significant geographic concentration. Net operating revenues generated by the Company’s hospitals in Indiana, as a percentage of consolidated net operating revenues, were 17.1% in 2023, 17.3% in 2022, and 16.4% in 2021. Net operating revenues generated by the Company’s hospitals in Alabama, as a percentage of consolidated net operating revenues, were 14.4% in 2023, 13.3% in 2022 and 13.0% in 2021. Net operating revenues generated by the Company’s hospitals in Texas, as a percentage of consolidated net operating revenues, were 11.7% in 2023, 11.7% in 2022 and 11.0% in 2021. Net operating revenues generated by the Company’s hospitals in Florida, as a percentage of consolidated net operating revenues, were 11.1% in 2023, 11.6% in 2022 and 12.2% in 2021.

Use of Estimates

Use of Estimates. The preparation of financial statements in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”) requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements. Actual results could differ from these estimates under different assumptions or conditions.

Principles of Consolidation

Principles of Consolidation. The consolidated financial statements include the accounts of the Parent Company, its subsidiaries, all of which are controlled by the Parent Company through majority voting control, and variable interest entities for which the Company is the primary beneficiary. All intercompany accounts, profits and transactions have been eliminated. Noncontrolling interests in less-than-wholly-owned consolidated subsidiaries of the Parent Company are presented as a component of total equity to distinguish between the interests of the Parent Company and the interests of the noncontrolling owners. Revenues, expenses and income from these subsidiaries are included in the consolidated amounts as presented in the consolidated statements of (loss) income, along with a net income measure that separately presents the amounts attributable to the controlling interests and the amounts attributable to the noncontrolling interests for each of the periods presented. Noncontrolling interests that are redeemable or may become redeemable at a fixed or determinable price at the option of the holder or upon the occurrence of an event outside of the control of the Company are presented in mezzanine equity in the consolidated balance sheets.

Cost of Revenue

Cost of Revenue. Substantially all of the Company’s operating costs and expenses are “cost of revenue” items. Operating costs that could be classified as general and administrative by the Company would include the Company’s corporate office costs at its Franklin, Tennessee office, which were collectively $248 million, $229 million and $222 million for the years ended December 31, 2023, 2022 and 2021, respectively. Included in these corporate office costs is stock-based compensation of $22 million, $20 million and $25 million for the years ended December 31, 2023, 2022 and 2021, respectively.

Cash Equivalents

Cash Equivalents. The Company considers highly liquid investments with original maturities of three months or less to be cash equivalents.

Supplies

Supplies. Supplies, principally medical supplies, are stated at the lower of cost (first-in, first-out basis) or market.

Marketable Securities

Marketable Securities. The Company’s marketable securities consist of debt securities that are classified as trading or available-for-sale and equity securities. Available-for-sale debt securities are reported at fair value as determined by quoted market prices, with unrealized gains and losses reported as a separate component of stockholders’ deficit. Trading securities are reported at fair value with unrealized gains and losses included in earnings. Other comprehensive income (loss), net of tax, included an unrealized gain of $6 million and unrealized losses of $17 million and $5 million during the years ended December 31, 2023, 2022 and 2021, respectively.

Property and Equipment

Property and Equipment. Property and equipment are recorded at cost. Depreciation is recognized using the straight-line method over the estimated useful lives of the land and improvements (3 to 20 years), buildings and improvements (5 to 40 years) and equipment and fixtures (3 to 18 years). Costs capitalized as construction in progress were $343 million and $234 million at December 31, 2023 and 2022, respectively. Expenditures for renovations and other significant improvements are capitalized; however, maintenance and repairs which do not improve or extend the useful lives of the respective assets are charged to operations as incurred.

Interest capitalized related to construction in progress was $13 million, $9 million and $13 million for the years ended December 31, 2023, 2022 and 2021, respectively. Purchases of property and equipment and internal-use software accrued in accounts payable and not yet paid were $101 million and $87 million at December 31, 2023 and 2022, respectively.

The Company also leases certain facilities and equipment under finance leases (see Note 9). Such assets are amortized on a straight-line basis over the lesser of the term of the lease or the remaining useful lives of the applicable assets. During the year ended December 31, 2023, the Company had non-cash investing activity of $1 million related to certain facility and equipment additions that were financed through finance leases and other debt.

Goodwill

Goodwill. Goodwill represents the excess of the fair value of the consideration conveyed in the acquisition over the fair value of net assets acquired. Goodwill arising from business combinations is not amortized. Goodwill is required to be evaluated for impairment at the same time every year and when an event occurs or circumstances change such that it is more likely than not that impairment may exist. The Company performs its annual testing of impairment for goodwill in the fourth quarter of each year. There was no goodwill impairment charge during the years ended December 31, 2023, 2022 and 2021 as a result of the Company’s annual impairment evaluation.

Other Assets

Other Assets. Other assets consist of the insurance recovery receivable from excess insurance carriers related to the Company’s self-insured professional liability and workers’ compensation insurance liability; costs to recruit physicians to the Company’s markets, which are deferred and expensed over the term of the respective physician recruitment contract, generally three years, and included in amortization expense; equity method investments; right-of-use (“ROU”) assets for operating leases; and capitalized internal-use software costs, which are expensed over the expected useful life, which is generally three years for routine software, and included in amortization expense.

Revenue Recognition

Revenue Recognition.

Net Operating Revenues

Net operating revenues are recorded at the transaction price estimated by the Company to reflect the total consideration due from patients and third-party payors in exchange for providing goods and services in patient care. These services are considered to be a single performance obligation and have a duration of less than one year. Revenues are recorded as these goods and services are provided. The transaction price, which involves significant estimates, is determined based on the Company’s standard charges for the goods and services provided, with a reduction recorded for price concessions related to third-party contractual arrangements as well as patient discounts and other patient price concessions. During each of the years ended December 31, 2023, 2022 and 2021, the impact of changes to the inputs used to determine the transaction price was considered immaterial.

Currently, several states utilize supplemental reimbursement programs for the purpose of providing reimbursement to providers that is not specifically tied to an individual’s care, some of which offsets a portion of the cost of providing care to Medicaid and indigent patients. These programs are authorized by Centers for Medicare & Medicaid Services (“CMS”) and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. Under these supplemental programs, the Company recognizes revenue and related expenses in the period in which amounts are estimable and payment is reasonably assured. Reimbursement under these programs is reflected in net operating revenues. Taxes or other program-related costs are reflected in other operating expenses.

The Company’s net operating revenues during the years ended December 31, 2023, 2022 and 2021 have been presented in the following table based on an allocation of the estimated transaction price with the patient between the primary patient classification of insurance coverage (in millions):


	Year Ended December 31,
	2023		2022		2021
Medicare	$	2,484	$	2,547	$	2,650
Medicare Managed Care		2,103		1,968		1,861
Medicaid		1,790		1,807		1,671
Managed Care and other third-party payors		5,978		5,806		6,076
Self-pay		135		83		110
Total	$	12,490	$	12,211	$	12,368

Patient Accounts Receivable

Patient accounts receivable are recorded at net realizable value based on certain assumptions determined by each payor. For third-party payors including Medicare, Medicare Managed Care, Medicaid and Managed Care, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay accounts receivable, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience without regard to aging category. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.

Patient accounts receivable can be impacted by the effectiveness of the Company’s collection efforts. Additionally, significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect the net realizable value of accounts receivable. The Company also continually reviews the net realizable value of accounts receivable by monitoring historical cash collections as a percentage of trailing net operating revenues, as well as by analyzing current period net operating revenues and admissions by payor classification, days revenue outstanding, the composition of self-pay receivables between pure self-pay patients and the patient responsibility portion of third-party insured receivables, the impact of recent acquisitions and dispositions and the impact of current macroeconomic conditions and other events.

Final settlements for some payors and programs are subject to adjustment based on administrative review and audit by third parties. As a result of these final settlements, the Company has recorded amounts due to third-party payors of $97 million and $101 million as of December 31, 2023 and 2022, respectively, and these amounts are included in accrued liabilities-other in the accompanying consolidated balance sheets. Amounts due from third-party payors were $130 million and $97 million as of December 31, 2023 and 2022, respectively, and are included in other current assets in the accompanying consolidated balance sheets. Substantially all Medicare and Medicaid cost reports are final settled through 2019.

Charity Care

In the ordinary course of business, the Company renders services to patients who are financially unable to pay for hospital care. The Company’s policy is to not pursue collections for such amounts; therefore, the related charges for those patients who are financially unable to pay and that otherwise do not qualify for reimbursement from a governmental program are not reported in net operating revenues, and are thus classified as charity care. The Company determines amounts that qualify for charity care based on the patient’s household income relative to the federal poverty level guidelines, as established by the federal government.

These charity care services are estimated to be $1.3 billion, $1.4 billion and $1.1 billion for the years ended December 31, 2023, 2022 and 2021, respectively, representing the value (at the Company’s standard charges) of these charity care services that are excluded from net operating revenues. The estimated cost incurred by the Company to provide these charity care services to patients who are unable to pay was approximately $140 million, $166 million and $123 million for the years ended December 31, 2023, 2022 and 2021, respectively. The estimated cost of these charity care services was determined using a ratio of cost to gross charges and applying that ratio to the gross charges associated with providing care to charity patients for the period. The Company determines amounts that qualify for charity care based on the patient’s household income relative to the federal poverty level guidelines, as established by the federal government. The Company updated its policy during the three months ended March 31, 2022 in a manner which increased the number of accounts qualifying for charity care. This resulted in an increase in charity care services during the year ended December 31, 2022, compared to the same period in 2021.

Leases

Leases. Leases are recorded in the consolidated balance sheets through recognition of a liability for the discounted present value of future fixed lease payments and a corresponding ROU asset. The ROU asset recorded at commencement of the lease represents the right to use the underlying asset over the lease term in exchange for the lease payments. Leases with an initial term of 12 months or less that do not have an option to purchase the underlying asset that is deemed reasonably certain to be exercised are not recorded in the consolidated balance sheets; rather, rent expense for these leases is recognized on a straight-line basis over the lease term, or when incurred if a month-to-month lease. When readily determinable, the Company uses the interest rate implicit in a lease to determine the present value of future lease payments. For leases where the implicit rate is not readily determinable, the Company’s incremental borrowing rate is utilized. The Company calculates its incremental borrowing rate on a quarterly basis using a third-party financial model that estimates the rate of interest the Company would have to pay to borrow an amount equal to the total lease payments on a collateralized basis over a term similar to the lease. The Company’s lease agreements do not contain any material residual value guarantees or material restrictive covenants.

Physician Income Guarantees

Physician Income Guarantees. The Company enters into physician recruiting agreements under which it supplements physician income to a minimum amount over a period of time, typically one year, while the physicians establish themselves in the community. As part of the agreements, the physicians are committed to practice in the community for a period of time, typically three years, which extends beyond their income guarantee period. The Company records an asset and liability for the estimated fair value of minimum revenue guarantees on new agreements and the asset is amortized over the life of each respective agreement. Adjustments to the ultimate value of the guarantee paid to physicians are recognized in the period that the change in estimate is identified. As of December 31, 2023 and 2022, the unamortized portion of these physician income guarantees was $9 million and $12 million, respectively, and is recorded in other assets in the consolidated balance sheets.

Concentrations of Credit Risk

Concentrations of Credit Risk. The Company grants unsecured credit to its patients, most of whom reside in the service area of the Company’s facilities and are insured under third-party payor agreements. Because of the economic diversity of the Company’s facilities and non-governmental third-party payors, Medicare represents the only significant concentration of credit risk from payors. Accounts receivable, net of contractual allowances, from Medicare was $194 million and $198 million at December 31, 2023 and 2022, respectively, representing 6% of consolidated net accounts receivable at both December 31, 2023 and 2022.

Accounting for the Impairment or Disposal of Long-Lived Assets

Accounting for the Impairment or Disposal of Long-Lived Assets. During the year ended December 31, 2023, the Company recorded a net gain of approximately $87 million, comprised of a gain of $145 million related to the sale of five hospitals and the sale of a majority interest in one hospital, offset by (i) an approximate $49 million impairment charge to adjust the carrying value of long-lived assets at three hospitals that were sold at a sales price below carrying value, and (ii) an approximate $9 million impairment charge recorded to reduce the carrying value of several assets that were idled, disposed of or held-for-sale. During the year ended December 31, 2023, approximately $186 million of goodwill was allocated from the hospital operations reporting unit associated with the disposal groups for which impairment charges or a gain on sale was recorded during the period.

During the year ended December 31, 2022, the Company recorded an impairment charge of approximately $71 million, of which (i) approximately $7 million was recorded to adjust the carrying value of long-lived assets at hospitals and related businesses that were sold at a sales price below carrying value, (ii) approximately $44 million was recorded to reduce the carrying value of closed hospitals to estimated fair value less costs to sell, (iii) approximately $9 million was recorded related to the expiration or planned non-renewal of leases to operate certain hospitals, and (iv) approximately $11 million was recorded to reduce the carrying value of several assets that were either idled, disposed or held-for-sale.

Income Taxes

Income Taxes. The Company accounts for income taxes under the asset and liability method, in which deferred income tax assets and liabilities are recognized for the tax consequences of “temporary differences” by applying enacted statutory tax rates applicable to future years to differences between the financial statement carrying amounts and the tax bases of existing assets and liabilities. The effect on deferred taxes of a change in tax rates is recognized in the consolidated statements of (loss) income during the period in which the tax rate change becomes law.

Comprehensive Loss

Other Comprehensive Loss. Other comprehensive loss is the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources.

Segment Reporting

Segment Reporting. A public company is required to report annual and interim financial and descriptive information about its reportable operating segments. Operating segments, as defined, are components of an enterprise about which separate financial information is available that is evaluated regularly by the chief operating decision maker in deciding how to allocate resources and in assessing performance. Aggregation of similar operating segments into a single reportable operating segment is permitted if the businesses have similar economic characteristics and meet the criteria established by U.S. GAAP. The Company operates a single operating segment represented by hospital operations (which includes the Company's acute care hospitals and related healthcare entities that provide inpatient and outpatient healthcare services).

COVID-19 Pandemic

VID-19 Pandemic. Throughout the acute phase of the COVID-19 pandemic that began in 2020, federal and state governments passed legislation, promulgated regulations and took other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients during the public health emergency and to provide financial relief. Various stimulus laws, including the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) and the American Rescue Plan Act of 2021 (the “ARPA”), among others, authorized significant funding to be distributed to eligible healthcare providers through the Public Health and Social Services Emergency Fund (the “PHSSEF”). PHSSEF payments were intended to compensate healthcare providers for lost revenues and incremental expenses incurred in response to the COVID-19 pandemic and are not required to be repaid, provided that recipients attest to and comply with certain terms and conditions, including audit and reporting requirements. Various state and local programs also exist to provide relief, either independently or through distribution of monies received via the CARES Act and other enacted federal legislation.

The Company received pandemic relief fund payments through various federal, state and local programs of approximately $161 million and $58 million during the years ended December 31, 2022 and 2021. Approximately $173 million and $148 million during the years ended December 31, 2022 and 2021, respectively, was recognized as pandemic relief funds within the consolidated statements of (loss) income. The Company did not receive or recognize any significant level of payments or benefits under the CARES Act or other COVID-19 related stimulus and relief legislation during the year ended December 31, 2023 and does not expect to receive or recognize any significant level of payments or benefit under the CARES Act and other existing legislation related to COVID-19 in future periods.

New Accounting Pronouncements

New Accounting Pronouncements. In November 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-07, “Segment Reporting (Topic 280), Improvements to Reportable Segment Disclosures.” This ASU includes additional requirements for the disclosure of significant segment expenses and segment measure(s) of profit or loss, as well as new disclosure requirements for entities with a single reportable segment and certain qualitative information about the chief operating decision maker. This ASU is effective for annual periods beginning after December 15, 2023 and interim periods beginning after December 15, 2024. The amendments in this ASU must be applied retrospectively to all periods presented. Early adoption is permitted. The Company is currently evaluating the impact that adoption of this ASU will have on its consolidated financial statements.

In December 2023, the FASB issued ASU 2023-09, “Income Taxes (Topic 740), Improvements to Income Tax Disclosures.” This ASU establishes new requirements for the categorization and disaggregation of information in the rate reconciliation as well as for disaggregation of income taxes paid. Additionally, this ASU modifies and eliminates certain existing requirements for indefinitely reinvested foreign earnings and unrecognized tax benefits. This ASU is effective for annual periods beginning after December 15, 2024 and interim periods beginning after December 15, 2025. The amendments in this ASU should be applied on a prospective basis and early adoption is permitted. The Company is currently evaluating the impact that adoption of this ASU will have on its consolidated financial statements.

The Company has evaluated all other recently issued, but not yet effective, ASUs and does not expect the eventual adoption of these ASUs to have a material impact on its consolidated financial position or results of operations.

Acquisitions

The Company accounts for all transactions that represent business combinations using the acquisition method of accounting, where the identifiable assets acquired, the liabilities assumed and any noncontrolling interest in the acquired entity are recognized and measured at their fair values on the date the Company obtains control in the acquiree. Such fair values that are not finalized for reporting periods following the acquisition date are estimated and recorded as provisional amounts. Adjustments to these provisional amounts during the measurement period (defined as the date through which all information required to identify and measure the consideration transferred, the assets acquired, the liabilities assumed and any noncontrolling interests has been obtained, limited to one year from the acquisition date) are recorded when identified. Goodwill is determined as the excess of the fair value of the consideration conveyed in the acquisition over the fair value of the net assets acquired.

The Company accounts for asset acquisitions pursuant to a cost accumulation model. Direct transaction costs are recognized as part of the cost of an acquisition. The Company also evaluates which elements of a transaction should be accounted for as part of an asset acquisition and which should be accounted for separately. The cost of an asset acquisition, including transaction costs, is allocated to identifiable assets acquired and liabilities assumed based on a relative fair value basis. Goodwill is not recognized in an asset acquisition.

Fair Value of Financial Instruments

The carrying value of the Company’s long-term debt in the above table is presented net of unamortized deferred debt issuance costs. The estimated fair value is determined using the methodologies discussed below in accordance with accounting standards related to the determination of fair value based on the U.S. GAAP fair value hierarchy as discussed in Note 8. The estimated fair value for financial instruments with a fair value that does not equal its carrying value is considered a Level 1 valuation. The Company utilizes the market approach and obtains indicative pricing through publicly available subscription services such as Bloomberg to determine fair values where relevant.

Cash and cash equivalents. The carrying amount approximates fair value due to the short-term maturity of these instruments (less than three months).

Investments in equity securities. Estimated fair value is based on closing price as quoted in public markets.

Available-for-sale debt securities. Estimated fair value is based on closing price as quoted in public markets or other various valuation techniques.

Trading securities. Estimated fair value is based on closing price as quoted in public markets.

Senior Notes, Senior Secured Notes and Junior-Priority Secured Notes. Estimated fair value is based on the closing market price for these notes.

ABL Facility and other debt. The carrying amount of the ABL Facility and all other debt approximates fair value due to the nature of these obligations.

Fair Value

Fair value is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions that market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, the Company utilizes the U.S. GAAP fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs that are classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumption about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

The inputs used to measure fair value are classified into the following fair value hierarchy:


Level 1:		Quoted market prices in active markets for identical assets or liabilities.
Level 2:		Observable market-based inputs or unobservable inputs that are corroborated by market data.
Level 3:		Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Level 3 includes values determined using pricing models, discounted cash flow methodologies, or similar techniques reflecting the Company’s own assumptions.

Legal Matters

Legal Matters. The Company is a party to various legal, regulatory and governmental proceedings incidental to its business. Based on current knowledge, management does not believe that loss contingencies arising from pending legal, regulatory and governmental matters will have a material adverse effect on the consolidated financial position or liquidity of the Company. However, in light of the inherent uncertainties involved in pending legal, regulatory and governmental matters, some of which are beyond the Company’s control, and the very large or indeterminate damages sought in some of these matters, an adverse outcome in one or more of these matters could be material to the Company’s results of operations or cash flows for any particular reporting period.

With respect to all legal, regulatory and governmental proceedings, the Company considers the likelihood of a negative outcome. If the Company determines the likelihood of a negative outcome with respect to any such matter is probable and the amount of the loss can be reasonably estimated, the Company records an accrual for the estimated loss for the expected outcome of the matter. If the likelihood of a negative outcome with respect to material matters is reasonably possible and the Company is able to determine an estimate of the possible loss or a range of loss, whether in excess of a related accrued liability or where there is no accrued liability, the Company discloses the estimate of the possible loss or range of loss. However, the Company is unable to estimate a possible loss or range of loss in some instances based on the significant uncertainties involved in, and/or the preliminary nature of, certain legal, regulatory and governmental matters.

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	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

Condensed Financial Information of Parent Company - Condensed Statements of Cash Flows (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net cash used in operating activities	$ 210	$ 300	$ (131)
Cash flows from investing activities:
Net cash provided by (used in) investing activities	(26)	(259)	(524)
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements	(4)	(8)	(5)
Net cash used in financing activities	(264)	(430)	(514)
Net change in cash and cash equivalents	(80)	(389)	(1,169)
Cash and cash equivalents at beginning of period	38	118	507	$ 1,676
Parent Company
Cash flows from operating activities:
Net cash used in operating activities	(85)	(13)	(11)
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements	(4)	(8)	(5)
Changes in intercompany balances with affiliates, net	89	21	16
Net cash used in financing activities	$ 85	$ 13	$ 11

Income Taxes - Schedule of Provision for Income Taxes (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 149		$ (46)
State	7	$ 5	6
Total, Current	156	5	(40)
Deferred:
Federal	(5)	166	161
State	40	(1)	10
Total, Deferred	35	165	171
Total provision for income taxes for income	$ 191	$ 170	$ 131

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Document and Entity Information - USD ($)	12 Months Ended
Document and Entity Information - USD ($)	Dec. 31, 2023	Feb. 14, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Transition Report	false
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Current Fiscal Year End Date	--12-31
Entity File Number	001-15925
Entity Registrant Name	COMMUNITY HEALTH SYSTEMS, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	13-3893191
Entity Address, Address Line One	4000 Meridian Boulevard
Entity Address, City or Town	Franklin
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37067
City Area Code	615
Local Phone Number	465-7000
Title of 12(b) Security	Common Stock, $.01 par value
Trading Symbol	CYH
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		136,737,166
Entity Central Index Key	0001108109
Amendment Flag	false
Entity Public Float			$ 546,992,362
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Auditor Firm ID	34
Auditor Name	Deloitte & Touche LLP
Auditor Location	Nashville, Tennessee
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Certain information required for Part III of this annual report is incorporated by reference to portions of the Registrant’s definitive proxy statement for its 2024 annual meeting of stockholders to be filed with the Securities and Exchange Commission within 120 days after the end of the Registrant’s fiscal year ended December 31, 2023.

Long-Term Debt - Other Debt - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt and Lease Obligation [Abstract]
Pre-tax gain from early extinguishment of debt	$ 72	$ 253	$ (79)
After-tax gain (loss) from extinguishment of debt	$ 61	$ 208	$ (116)

Condensed Financial Information of Parent Company (Tables)

12 Months Ended

Dec. 31, 2023

Condensed Financial Information Disclosure [Abstract]

Condensed Balance Sheets


Parent Company Only
Condensed Balance Sheets
(In millions)
	December 31,
	2023			2022
ASSETS
Prepaid income taxes	$	77		$	99
Total current assets		77			99
Deferred income taxes		29			49
Other assets, net		—			—
Total assets	$	106		$	148
LIABILITIES AND STOCKHOLDERS' DEFICIT
Intercompany payable	$	1,083		$	1,159
Deferred income taxes		369			354
Other long-term liabilities		46			2
Total liabilities		1,498			1,515
Community Health Systems, Inc. stockholders’ deficit:
Preferred stock		—			—
Common stock		1			1
Additional paid-in capital		2,185			2,084
Accumulated other comprehensive loss		(14	)		(21	)
Accumulated deficit		(3,564	)		(3,431	)
Total Community Health Systems, Inc. stockholders’ deficit		(1,392	)		(1,367	)
Total liabilities and stockholders' deficit	$	106		$	148

See note to condensed financial statements of Parent Company.

Condensed Statements of (Loss) Income


Parent Company Only
Condensed Statements of (Loss) Income
(In millions)
	Year Ended December 31,
	2023			2022			2021
Net operating revenues	$	—		$	—		$	—
Operating costs and expenses:
Salaries and benefits		—			—			—
Supplies		—			—			—
Other operating expenses		—			—			—
Lease cost and rent		—			—			—
Pandemic relief funds		—			—			—
Depreciation and amortization		—			—			—
Impairment and (gain) loss on sale of businesses, net		—			—			—
Total operating costs and expenses		—			—			—
Income from operations		—			—			—
Interest expense, net		—			—			—
(Gain) loss from early extinguishment of debt		—			—			—
Equity in loss (earnings) of unconsolidated affiliates		133			(46	)		(230	)
(Loss) income before income taxes		(133	)		46			230
Provision for (benefit from) income taxes		—			—			—
Net (loss) income		(133	)		46			230
Less: Net income attributable to noncontrolling interests		—			—			—
Net (loss) income attributable to Community Health Systems, Inc. stockholders	$	(133	)	$	46		$	230

See note to condensed financial statements of Parent Company.

Condensed Statements of Comprehensive (Loss) Income


Parent Company Only
Condensed Statements of Comprehensive (Loss) Income
(In millions)
	Year Ended December 31,
	2023			2022			2021
				(In millions)
Net (loss) income	$	(133	)	$	46		$	230
Equity in other comprehensive (loss) income of affiliates, net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax		6			(17	)		(5	)
Amortization and recognition of unrecognized pension cost components, net of tax		1			10			3
Other comprehensive income (loss)		7			(7	)		(2	)
Comprehensive (loss) income		(126	)		39			228
Less: Comprehensive income attributable to noncontrolling interests		—			—			—
Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders	$	(126	)	$	39		$	228

See note to condensed financial statements of Parent Company.

Condensed Statements of Cash Flows


Parent Company Only
Condensed Statements of Cash Flows
(In millions)
	Year Ended December 31,
	2023			2022			2021
Cash flows from operating activities:
Net cash used in operating activities	$	(85	)	$	(13	)	$	(11	)
Cash flows from investing activities:
Net cash provided by (used in) investing activities		—			—			—
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements		(4	)		(8	)		(5	)
Changes in intercompany balances with affiliates, net		89			21			16
Net cash provided by financing activities		85			13			11
Net change in cash and cash equivalents		—			—			—
Cash and cash equivalents at beginning of period		—			—			—
Cash and cash equivalents at end of period	$	—		$	—		$	—

See note to condensed financial statements of Parent Company.

Goodwill and Other Intangible Assets - Intangible Assets - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Finite Lived Intangible Assets [Line Items]
Finite-lived intangible assets acquired during the year		$ 0
Finite-lived intangible assets, gross	$ 27,000,000	4,000,000
Finite-Lived intangible assets, net	20,000,000	2,000,000
Net, intangible asset not subject to amortization	41,000,000	50,000,000
Gross carrying amount of capitalized software	959,000,000	968,000,000
Capitalized computer software, net	144,000,000	170,000,000
Capitalized computer software, development stage costs	68,000,000
Finite-Lived Intangible Assets, Except Capitalized Internal-Use Software
Finite Lived Intangible Assets [Line Items]
Amortization expense	5,000,000	1,000,000	$ 1
Amortization expense for 2024	8,000,000
Amortization expense for 2025	8,000,000
Amortization expense for 2026	$ 4,000,000
Capitalized Internal Use Software, Significant System Conversions
Finite Lived Intangible Assets [Line Items]
Weighted-average amortization period	3 years
Capitalized Internal Use Software
Finite Lived Intangible Assets [Line Items]
Amortization expense	$ 80,000,000	$ 85,000,000	$ 108,000,000
Amortization expense for 2024	57,000,000
Amortization expense for 2025	39,000,000
Amortization expense for 2026	27,000,000
Amortization expense for 2027	12,000,000
Amortization expense for 2028	7,000,000
Amortization expense thereafter	2,000,000
Acquired finite-lived intangible asset, residual value	$ 0

Long-Term Debt - Schedule of Early Redemption Prices 6.875% Junior-Priority Secured Notes due 2029 (Details) - Junior-Priority Secured Notes at 6.875% Due 2029 - Junior-Priority Secured Notes	Feb. 02, 2021
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	103.438%
Debt Instrument, Redemption Period, Start Date	Apr. 15, 2024
Debt Instrument, Redemption Period, End Date	Apr. 14, 2025
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	101.719%
Debt Instrument, Redemption Period, Start Date	Apr. 15, 2025
Debt Instrument, Redemption Period, End Date	Apr. 14, 2026
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Apr. 15, 2026
Debt Instrument, Redemption Period, End Date	Apr. 14, 2029

Long-Term Debt - Schedule of Debt (Parenthetical) (Details)						12 Months Ended
	Dec. 22, 2023	Feb. 04, 2022	May 19, 2021	Feb. 09, 2021	Feb. 02, 2021	Dec. 31, 2023	Dec. 31, 2022	Nov. 19, 2019	Mar. 06, 2019
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage						8.00%	8.00%		8.00%
Debt instrument, maturity year						2026	2026
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2027
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage						8.00%	8.00%	8.00%
Debt instrument, maturity year						2027	2027
Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage						5.625%	5.625%
Debt instrument, maturity year						2027	2027
Senior Secured Notes \| Senior Secured Notes at 6%, Due 2029
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage						6.00%	6.00%
Debt instrument, maturity year						2029	2029
Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		5.25%				5.25%	5.25%
Debt instrument, maturity year		2030				2030	2030
Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage				4.75%		4.75%	4.75%
Debt instrument, maturity year				2031		2031	2031
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	10.875%					10.875%	10.875%
Debt instrument, maturity year	2032					2032	2032
Senior Notes \| Senior Notes at 6.875%, Due 2028
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage						6.875%	6.875%
Debt instrument, maturity year						2028	2028
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875%, Due 2029
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage					6.875%	6.875%	6.875%
Debt instrument, maturity year					2029	2029	2029
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125%, Due 2030
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage			6.125%			6.125%	6.125%
Debt instrument, maturity year			2030			2030	2030

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2023

Commitments and Contingencies Disclosure [Abstract]

Schedule of Reconciliation of the Beginning and Ending Liability Balances in Connection with Probable Contingencies

The table below presents a reconciliation of the beginning and ending liability balances (in millions) during the years ended December 31, 2023 and 2022, with respect to the Company’s determination of the contingencies of the Company in respect of which an accrual has been recorded. The liability as of December 31, 2023 is comprised of individually insignificant amounts for various matters.


	Probable
	Contingencies
Balance as of December 31, 2021	$	20
Expense		8
Reserve for insured claim		—
Cash payments		(17	)
Balance as of December 31, 2022		11
Expense		38
Reserve for insured claim		5
Cash payments		(47	)
Balance as of December 31, 2023	$	7

Condensed Financial Information of Parent Company - Condensed Statements of (Loss) Income (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Condensed Income Statements Captions [Line Items]
Net operating revenues	$ 12,490	$ 12,211	$ 12,368
Operating costs and expenses:
Salaries and benefits	5,415	5,330	5,242
Supplies	1,993	1,975	2,042
Other operating expenses	3,388	3,336	2,958
Pandemic relief funds		(173)	(148)
Depreciation and amortization	505	534	540
Impairment and (gain) loss on sale of businesses, net	(87)	71	24
Total operating costs and expenses	11,533	11,390	10,966
Income from operations	957	821	1,402
Interest expense, net	830	858	885
Gain (loss) on early extinguishment of debt	72	253	(79)
(Loss) income before income taxes	207	349	499
Provision for income taxes	191	170	131
Net (loss) income	16	179	368
Less: Net income attributable to noncontrolling interests	149	133	138
Net (loss) income attributable to Community Health Systems, Inc. stockholders	(133)	46	230
Parent Company
Operating costs and expenses:
Equity in loss (earnings) of unconsolidated affiliates	133	(46)	(230)
(Loss) income before income taxes	(133)	46	230
Net (loss) income	(133)	46	230
Net (loss) income attributable to Community Health Systems, Inc. stockholders	$ (133)	$ 46	$ 230

Employee Benefit Plans - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Defined Benefit Plan Disclosure [Line Items]
Defined Contribution Plan, Cost Recognized	$ 64,000,000	$ 70,000,000	$ 65,000,000
Liability for deferred compensation plans	123,000,000	127,000,000
Defined benefit plan, noncash settlement loss	0	0	0
Pension Plans, Defined Benefit [Member]
Defined Benefit Plan Disclosure [Line Items]
Accrued benefits liabilities	$ 2,000,000	$ 2,000,000
Defined benefit plans and other post-retirement plans, weighted-average assumptions to determine net periodic cost, discount rates	5.20%	2.80%
Expected long-term rates of return on assets	5.50%	4.30%
Pension Plans, Defined Benefit [Member] \| Maximum
Defined Benefit Plan Disclosure [Line Items]
Net periodic benefit cost	$ 1,000,000	$ 1,000,000	1,000,000
Settlement charge			1,000,000
Defined Benefit Plan, Net Periodic Benefit (Cost) Credit, Settlement Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration]	Salaries and benefits
Deferred Compensation Plans Equity Securities [Member]
Defined Benefit Plan Disclosure [Line Items]
Liability for deferred compensation plans	$ 15,000,000	46,000,000
Deferred Compensation Company-Owned Life Insurance Contracts [Member]
Defined Benefit Plan Disclosure [Line Items]
Liability for deferred compensation plans	111,000,000	135,000,000
Trust for Benefit of Employees [Member] \| Pension Plans, Defined Benefit [Member]
Defined Benefit Plan Disclosure [Line Items]
Defined benefit plan assets designated to pay benefits of the deferred compensation plans	126,000,000	181,000,000
Supplemental Employee Retirement Plans, Defined Benefit [Member]
Defined Benefit Plan Disclosure [Line Items]
Net periodic benefit cost	8,000,000	11,000,000	$ 11,000,000
Accrued benefits liabilities	$ 42,000,000	$ 91,000,000
Defined benefit plans and other post-retirement plans, weighted-average assumptions to determine net periodic cost, discount rates	5.10%	2.70%
Defined benefit plans and other post-retirement plans, weighted-average assumptions to determine net periodic cost, rate of compensation increase	3.00%	3.00%

Long-Term Debt - 8% Senior Secured Notes, Due 2026 - Additional Information (Details) - USD ($)			12 Months Ended
	Nov. 19, 2019	Mar. 06, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 22, 2023
Debt Instrument [Line Items]
Extinguishment of debt amount			$ 402,000,000	$ 645,000,000
Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument aggregate principal amount	$ 500,000,000
Credit Facility, Term Loan H
Debt Instrument [Line Items]
Extinguishment of debt amount		$ 1,557,000,000
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument, offering date			Mar. 06, 2019
Debt instrument aggregate principal amount	2,101,000,000	$ 1,601,000,000			$ 985,000,000
Debt instrument stated interest rate		8.00%	8.00%	8.00%
Senior Secured Notes \| Senior Notes at 7.125%, Due 2020
Debt Instrument [Line Items]
Extinguishment of debt amount	$ 121,000,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Commitments and Contingencies - Schedule of Reconciliation of the Beginning and Ending Liability Balances in Connection with Probable Contingencies (Details) - Pending Litigation [Member] - Other Probable Contingencies [Member] - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Loss Contingency Accrual [Roll Forward]
Beginning Balance	$ 11	$ 20
Expense	38	8
Reserve for insured claim	5
Cash payments	(47)	(17)
Ending Balance	$ 7	$ 11

Accounting for Stock-Based Compensation

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

ACCOUNTING FOR STOCK-BASED COMPENSATION

2. ACCOUNTING FOR STOCK-BASED COMPENSATION

Stock-based compensation awards have been granted under the Community Health Systems, Inc. Amended and Restated 2009 Stock Option and Award Plan, which was most recently amended and restated as of March 22, 2023 and most recently approved by the Company’s stockholders at the annual meeting of stockholders held on May 9, 2023 (the “2009 Plan”).

The 2009 Plan provides for the grant of incentive stock options intended to qualify under Section 422 of the Internal Revenue Code (“IRC”) and for the grant of stock options which do not so qualify, stock appreciation rights, restricted stock, restricted stock units (“RSUs”), performance-based shares or units and other share awards. Persons eligible to receive grants under the 2009 Plan include the Company’s directors, officers, employees and consultants. To date, all options granted under the 2009 Plan have been “nonqualified” stock options for tax purposes. Generally, these options vest in one-third increments on each of the first three anniversaries of the option grant date and expire on the tenth anniversary of the option grant date. The exercise price of all options granted under the 2009 Plan is equal to the fair value of the Company’s common stock on the option grant date. As of December 31, 2023, 9,017,113 shares of unissued common stock were reserved for future grants under the 2009 Plan.

The following table reflects the impact of total compensation expense related to stock-based equity plans on the reported operating results for the respective periods (in millions):


	Year Ended December 31,
	2023			2022			2021
Effect on income before income taxes	$	(22	)	$	(20	)	$	(25	)
Effect on net income	$	(17	)	$	(15	)	$	(20	)

At December 31, 2023, $27 million of unrecognized stock-based compensation expense related to outstanding unvested stock options, restricted stock and RSUs (the terms of which are summarized below) was expected to be recognized over a weighted-average period of 20 months. Of that amount, $5 million related to outstanding unvested stock options was expected to be recognized over a weighted-average period of 20 months and $22 million related to outstanding unvested restricted stock and RSUs was expected to be recognized over a weighted-average period of 20 months. There were no modifications to awards during the years ended December 31, 2023, 2022 and 2021.

The fair value of stock options was estimated using the Black Scholes option pricing model with the following assumptions and weighted-average fair values during the years ended December 31, 2023, 2022 and 2021:


	Year Ended December 31,
	2023		2022		2021
Expected volatility	87.3%		84.3% - 87.5%		84.3% - 88.9%
Expected dividends		—		—		—
Expected term	6 years		3 - 6 years		3 - 6 years
Risk-free interest rate	4.2%		1.5% - 1.6%		0.3% - 0.9%

In determining the expected term, the Company examined concentrations of option holdings and historical patterns of option exercises and forfeitures, as well as forward-looking factors, in an effort to determine if there were any discernible employee populations. From this analysis, in determining the expected term for the year ended December 31, 2023, the Company identified one population, consisting of persons receiving grants of stock options. Additionally, in determining the expected term for the years ended December 31, 2022 and 2021, two populations were identified, one consisting of certain senior executives who have since retired as executive officers, and the other consisting of substantially all other recipients.

The expected volatility rate was estimated based on historical volatility. In determining expected volatility, the Company also reviewed the market-based implied volatility of actively traded options of its common stock and determined that historical volatility utilized to estimate the expected volatility rate did not differ significantly from the implied volatility.

The expected term computation is based on historical exercise and cancellation patterns and forward-looking factors, where present, for each population identified. The risk-free interest rate is based on the U.S. Treasury yield curve in effect at the time of the grant. The pre-vesting forfeiture rate is based on historical rates and forward-looking factors for each population identified. The Company adjusts the estimated forfeiture rate to its actual experience.

Options outstanding and exercisable under the 2009 Plan as of December 31, 2023, and changes during each of the years in the three-year period prior to December 31, 2023, were as follows (in millions, except share and per share data):


	Shares			Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term	Aggregate Intrinsic Value as of December 31, 2023
Outstanding at December 31, 2020		1,817,525		$	8.77
Granted		749,250			8.81
Exercised		(65,499	)		5.03
Forfeited and cancelled		(199,523	)		33.14
Outstanding at December 31, 2021		2,301,753			6.77
Granted		760,000			10.18
Exercised		(56,500	)		4.97
Forfeited and cancelled		(173,502	)		13.41
Outstanding at December 31, 2022		2,831,751			7.32
Granted		814,000			6.15
Exercised		(15,001	)		4.95
Forfeited and cancelled		—			—
Outstanding at December 31, 2023		3,630,750		$	7.07	7.3 years	$	—
Exercisable at December 31, 2023		2,071,994		$	6.46	6.4 years	$	—

The weighted-average grant date fair value of stock options granted during the years ended December 31, 2023, 2022 and 2021, was $4.61, $7.25 and $6.22, respectively. The aggregate intrinsic value (calculated as the number of in-the-money stock options multiplied by the difference between the Company’s closing stock price on the last trading day of the reporting period ($3.13) and the exercise price of the respective stock options) in the table above represents the amount that would have been received by the option holders had all option holders exercised their options on December 31, 2023. This amount changes based on the market value of the Company’s common stock. The aggregate intrinsic value of options exercised during the years ended December 31, 2023, 2022 and

2021 was less than $1 million for all three years. The aggregate intrinsic value of options vested and expected to vest approximates that of the outstanding options.

The Company has also awarded restricted stock under the 2009 Plan to employees of certain subsidiaries. With respect to time-based vesting restricted stock that has been awarded under the 2009 Plan, the restrictions on these shares have generally lapsed in one-third increments on each of the first three anniversaries of the award date. In addition, certain of the restricted stock awards granted to the Company’s senior executives have contained performance objectives required to be met in addition to any time-based vesting requirements. If the applicable performance objectives are not attained, these awards will be forfeited in their entirety. For performance-based awards, the performance objectives are measured cumulatively over a three-year period. If the applicable target performance objective is met at the end of the three-year period, then the restricted stock award subject to such performance objective will vest in full on the third anniversary of the award date. Additionally, for these performance-based awards, based on the level of achievement for the applicable performance objective within the parameters specified in the award agreement, the number of shares to be issued in connection with the vesting of the award may be adjusted to decrease or increase the number of shares specified in the original award. Notwithstanding the above-mentioned performance objectives and vesting requirements, the restrictions with respect to restricted stock granted under the 2009 Plan may lapse earlier in the event of death, disability, change in control of the Company or, other than for performance-based awards, termination of employment by the Company for any reason other than for cause of the holder of the restricted stock. On March 1, 2023, restricted stock awards subject to performance objectives granted on March 1, 2020 vested at 100% of the shares originally granted based on the Company’s cumulative performance compared to objectives for the 2020 through 2022 performance period. Restricted stock awards subject to performance objectives that have not yet been satisfied are not considered outstanding for purposes of determining diluted earnings per share unless the performance objectives have been satisfied on the basis of results through the end of each respective reporting period.

Restricted stock outstanding under the 2009 Plan as of December 31, 2023, and changes during each of the years in the three-year period prior to December 31, 2023, were as follows:


	Shares			Weighted- Average Grant Date Fair Value
Unvested at December 31, 2020		4,555,735		$	4.84
Granted		2,929,250			8.16
Vested		(2,312,328	)		4.68
Forfeited		(177,343	)		6.33
Unvested at December 31, 2021		4,995,314			6.30
Granted		3,253,000			8.95
Vested		(2,561,575	)		5.70
Forfeited		(145,674	)		8.89
Unvested at December 31, 2022		5,541,065			8.53
Granted		2,746,000			6.04
Vested		(2,164,570	)		6.85
Forfeited		(68,672	)		8.16
Unvested at December 31, 2023		6,053,823			8.00

RSUs have been granted to the Company’s non-management directors under the 2009 Plan. Each of the Company’s then serving non-management directors received grants under the 2009 Plan of 29,268 RSUs, 17,682 RSUs and 19,296 RSUs on March 1, 2023, 2022 and 2021, respectively. Both the March 2023 and 2022 grants had a grant date fair value of approximately $180,000 and the March 2021 grant had a fair value of approximately $170,000. In addition to the grants set forth above, on March 1, 2023, the non-employee Chairman of the Board of Directors was awarded an additional RSU grant of 43,089 RSUs with a grant date fair value of approximately $265,000 as additional compensation for serving as Chairman of the Board of Directors. Vesting of these RSUs occurs in one-third increments on each of the first three anniversaries of the award date or upon the director’s earlier cessation of service on the board, other than for cause. Each non-management director may elect, prior to the beginning of the calendar year in which the award is granted, to defer the receipt of shares of the Company’s common stock issuable upon vesting until either his or her (i) separation from service with the Company or (ii) attainment of an age specified in advance by the non-management director. A total of four directors elected to defer the receipt of RSUs granted on March 1, 2021 and March 1, 2023 to a future date and a total of three directors elected to defer the receipt of RSUs granted on March 1, 2022 to a future date.

RSUs outstanding under the 2009 Plan as of December 31, 2023, and changes during each of the years in the three-year period prior to December 31, 2023, were as follows:


	Shares			Weighted- Average Grant Date Fair Value
Unvested at December 31, 2020		613,739		$	4.89
Granted		173,664			8.81
Vested		(300,805	)		5.09
Forfeited		—			—
Unvested at December 31, 2021		486,598			6.17
Granted		176,820			9.66
Vested		(151,058	)		5.63
Forfeited		—			—
Unvested at December 31, 2022		512,360			7.54
Granted		365,037			6.15
Vested		(101,471	)		7.75
Forfeited		—			—
Unvested at December 31, 2023		775,926			6.86

Long-Term Debt - 6.875% Senior Notes, Due 2028 - Additional Information (Details) - USD ($) shares in Millions			12 Months Ended
	Dec. 07, 2020	Nov. 19, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Gain (loss) on early extinguishment of debt			$ 72,000,000	$ 253,000,000	$ (79,000,000)
Extinguishment of debt amount			$ 402,000,000	$ 645,000,000
Senior Notes \| Senior Notes At 6.875% Due 2028
Debt Instrument [Line Items]
Debt instrument aggregate principal amount	$ 700,000,000	$ 1,700,000,000
Debt instrument stated interest rate		6.875%
Cash proceeds received in exchange offer		$ 0
Debt instrument, maturity date		Apr. 01, 2028
Minimum period notice for redemption of debt		15 days
Aggregate consideration from debt instrument exchanged for cash	$ 400,000,000
Debt instrument converted into shares of common stock	10
Gain (loss) on early extinguishment of debt	$ 205,000,000
Extinguishment of debt amount						$ 226,000,000
Extinguishment of debt amount via tender offer						$ 7,000,000
Tender offer commencement date						Oct. 30, 2020
Tender offer expiration date						Nov. 30, 2020

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

INCOME TAXES

5. INCOME TAXES

The provision for income taxes consists of the following (in millions):


	Year Ended December 31,
	2023			2022			2021
Current:
Federal	$	149		$	—		$	(46	)
State		7			5			6
		156			5			(40	)
Deferred:
Federal		(5	)		166			161
State		40			(1	)		10
		35			165			171
Total provision for income taxes for income	$	191		$	170		$	131

The following table reconciles the differences between the statutory federal income tax rate and the effective tax rate (dollars in millions):


	Year Ended December 31,
	2023						2022						2021
	Amount			%			Amount			%			Amount			%
Provision for income taxes at statutory federal rate	$	44			21.0	%	$	73			21.0	%	$	105			21.0	%
State income taxes, net of federal income tax benefit		37			17.9			3			0.8			44			8.7
Net income attributable to noncontrolling interests		(31	)		(14.9	)		(28	)		(8.0	)		(29	)		(5.8	)
Change in valuation allowance		88			42.5			122			34.9			33			6.8
Change in uncertain tax position		10			4.9			—			—			—			—
Nondeductible goodwill		29			14.1			—			—			—			—
Amended return adjustments		9			4.3			—			—			(22	)		(4.4	)
Other		5			2.5			—			—			—			—
Provision for income taxes and effective tax rate for income	$	191			92.3	%	$	170			48.7	%	$	131			26.3	%

The Company’s effective tax rates were 92.3%, 48.7% and 26.3% for the years ended December 31, 2023, 2022 and 2021, respectively. The increase in the Company’s effective tax rate for the year ended December 31, 2023, when compared to the year ended December 31, 2022, was primarily due to non-deductible goodwill related to hospitals divested in 2023 and a decrease in income before taxes. The increase in the Company’s effective tax rate for the year ended December 31, 2022, when compared to the year ended December 31, 2021, was primarily due to an increase in non-deductible interest for 2022 compared to 2021, compounded by an adverse change in the IRC Section 163(j) limit for deductible interest expense beginning in 2022.

Deferred income taxes are based on the estimated future tax effects of differences between the financial statement and tax bases of assets and liabilities under the provisions of the enacted tax laws. Deferred income taxes as of December 31, 2023 and 2022 consist of (in millions):


	December 31,
	2023					2022
	Assets			Liabilities		Assets			Liabilities
Net operating loss and credit carryforwards	$	533		$	—	$	553		$	—
Property and equipment		—			326		—			323
Self-insurance liabilities		16			—		30			—
Prepaid expenses		—			30		—			31
Intangibles		—			163		—			148
Investments in unconsolidated affiliates		—			72		—			58
Other liabilities		—			7		—			9
Long-term debt and interest		32			—		41			—
Accounts receivable		16			—		16			—
IRC Section 163(j) interest limitation		582			—		448			—
Accrued vacation		19			—		19			—
Accrued bonus		27			—		19			—
Other comprehensive income		4			—		6			—
Right-of-use assets		—			165		—			148
Right-of-use liability		173			—		156			—
Stock-based compensation		4			—		5			—
Deferred compensation		38			—		51			—
IRC Section 481(a) adjustments		—			57		—			122
Other		19			—		19			—
Total		1,463			820		1,363			839
Valuation allowance		(983	)		—		(829	)		—
Total deferred income taxes	$	480		$	820	$	534		$	839

The Company believes that the net deferred tax assets will ultimately be realized, except as noted below. Its conclusion is based on its estimate of future taxable income and the expected timing of temporary difference reversals. The Company has gross state net operating loss carryforwards of approximately $9.9 billion, which expire from 2024 through 2043. The Company’s tax affected federal and state net operating loss and credit carryforwards are approximately less than $1 million and $533 million, respectively. A valuation allowance of approximately $983 million has been recognized for state net operating loss carryforwards, state credit carryforwards and federal and state deferred tax assets that the Company does not expect to be able to realize. With respect to the deferred tax liability pertaining to intangibles, as included above, goodwill purchased in connection with certain of the Company’s business acquisitions is amortizable for income tax reporting purposes. However, for financial reporting purposes, there is no corresponding amortization allowed with respect to such purchased goodwill.

The valuation allowance for federal and state jurisdictions where the Company concluded that the associated deferred tax assets would not be realized increased by $88 million and $66 million, respectively, for the year ended December 31, 2023, and increased by $122 million and decreased by $108 million, respectively, for the year ended December 31, 2022.

The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was $45 million as of December 31, 2023. A total of $2 million of interest and penalties is included in the amount of the liability for uncertain tax positions at December 31, 2023. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its consolidated statements of (loss) income as income tax expense.

It is possible the amount of unrecognized tax benefit could change in the next 12 months as a result of a lapse of the statute of limitations and settlements with taxing authorities; however, the Company does not anticipate the change will have a material impact on the Company’s consolidated results of operations or consolidated financial position.

The following is a tabular reconciliation of the total amount of unrecognized tax benefit for the years ended December 31, 2023, 2022 and 2021 (in millions):


	Year Ended December 31,
	2023			2022		2021
Unrecognized tax benefit, beginning of year	$	50		$	42	$	45
Gross increases — tax positions in current period		9			8		5
Reductions — tax positions in prior period		(1	)		—		(8	)
Unrecognized tax benefit, end of year	$	58		$	50	$	42

The Company’s income tax return for the 2018 tax year remains under examination by the Internal Revenue Service. The Company believes the result of this examination will not be material to its consolidated results of operations or consolidated financial position. The Company has extended the federal statute of limitations through June 30, 2025 for Community Health Systems, Inc. for the tax period ended December 31, 2018.

Cash paid for income taxes, net of refunds received, was $91 million, $6 million and $4 million during the years ended December 31, 2023, 2022 and 2021, respectively.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

Pay vs Performance Disclosure - USD ($) $ in Millions	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net Income (Loss)	$ (133)	$ 46	$ 230

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2003/role/disclosureRef
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Reference 27: http://www.xbrl.org/2003/role/disclosureRef
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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Earnings Per Share

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Earnings Per Share

12. EARNINGS PER SHARE

The following table sets forth the components of the denominator for the computation of basic and diluted (loss) earnings per share for net (loss) income attributable to Community Health Systems, Inc. stockholders:


	Year Ended December 31,
	2023		2022		2021
Weighted-average number of shares outstanding — basic		130,445,677		128,808,387		126,754,852
Effect of dilutive securities:
Restricted stock awards		—		842,055		2,803,938
Employee stock options		—		278,057		726,130
Other equity-based awards		—		131,820		312,490
Weighted-average number of shares outstanding — diluted		130,445,677		130,060,319		130,597,410

The Company generated a net loss attributable to Community Health Systems, Inc. stockholders for the year ended December 31, 2023, so the effect of dilutive securities is not considered because their effect would be antidilutive. If the Company had generated net income, the effect of stock awards and options on the diluted shares calculation would have been an increase of 422,487 shares during the year ended December 31, 2023.


	Year Ended December 31,
	2023		2022		2021
Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:
Employee stock options and restricted stock awards		6,210,811		4,406,764		774,981

Long-Term Debt - Schedule of Early Redemption Prices 6.125% Junior-Priority Secured Notes due 2030 (Details) - Junior-Priority Secured Notes at 6.125% Due 2030 - Junior-Priority Secured Notes	May 19, 2021
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	103.063%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2025
Debt Instrument, Redemption Period, End Date	Mar. 31, 2026
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	101.531%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2026
Debt Instrument, Redemption Period, End Date	Mar. 31, 2027
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2027
Debt Instrument, Redemption Period, End Date	Mar. 31, 2030

Commitments and Contingencies - Additional Information (Details) - USD ($)	3 Months Ended		12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Commitments And Contingencies [Line Items]
Physician recruiting commitment, physician income guarantee period			12 months
Physician recruiting commitment, period of recoverability of physician income guarantee for noncommitment			3 years
Physician recruiting commitment, maximum potential future payments in excess of liability recorded			$ 6,000,000
Malpractice Loss Contingency, Discount Rate			3.70%	3.80%	1.80%
Malpractice Loss Contingency, Accrual, Discounted	$ 467,000,000		$ 443,000,000	$ 467,000,000
Malpractice Loss Contingency, Accrual, Undiscounted	516,000,000		498,000,000	516,000,000
Malpractice Loss Contingency, Accrual, Discounted, Current	159,000,000		119,000,000	159,000,000
Expenses related to settlement of professional liability claim						$ 50,000,000
Recovery of full settlement amount						$ 50,000,000
Recovery from third-party insurers of professional liability claim		$ 22,000,000
Change in estimate reserve for professional liability claims			0	0	$ 0
Change in estimate for professional liability claims	$ 15,000,000			$ 15,000,000
Professional and general liability self-insured claims reported prior to June 1, 2002, per occurrence [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			1,000,000
Professional and general liability self-insured reported from June 1, 2002 through June 1, 2003, per occurrence [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			2,000,000
Professional and general liability self-insured reported from June 1, 2003 and before June 1, 2005, per occurrence [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			4,000,000
Professional and general liability self-insured claims reported on or after June 1, 2005, per occurrence [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			5,000,000
Professional and general liability claims reported on or after June 1, 2014 [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			10,000,000
Professional and general liability claims reported on or after June 1, 2003 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Maximum Coverage Per Incident			95,000,000
Professional and general liability claims incurred and reported after January 1, 2008 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Maximum Coverage Per Incident			145,000,000
Professional and general liability claims incurred and reported after June 1, 2010 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Maximum Coverage Per Incident			195,000,000
Professional and general liability claims reported on or after June 1, 2015 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Maximum Coverage Per Incident			215,000,000
Integrated professional liability claims reported on or after June1 2014 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Annual Coverage Limit			50,000,000
Integrated occurrence claims reported on or after June 1, 2015 through June 1, 2020 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Annual Coverage Limit			75,000,000
Integrated occurrence claims reported between June 1, 2020 and June 1, 2024 [Member]
Commitments And Contingencies [Line Items]
Malpractice Insurance, Annual Coverage Limit			75,000,000
Professional and general liability self-insured claims under certain policy terms until Company total aggregate coverage is met if first aggregate layer becomes fully utilized [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			$ 10,000,000
Maximum
Commitments And Contingencies [Line Items]
Malpractice loss contingency, average lag period from occurrence to settlement			4 years
Malpractice loss contingency, settled claims as percent of total liability			1.00%
Maximum \| Professional And General Liability Claims Incurred And Reported On Or After June 1, 2008 [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			$ 15,000,000
Minimum
Commitments And Contingencies [Line Items]
Malpractice loss contingency, average lag period from occurrence to settlement			3 years
Minimum \| Professional and general liability self-insured claims under certain policy terms until Company total aggregate coverage is met if first aggregate layer becomes fully utilized [Member]
Commitments And Contingencies [Line Items]
Malpractice loss contingency, self-insured retention			$ 15,000,000
Northwest Health – Starke [Member]
Commitments And Contingencies [Line Items]
Capital commitment, future period after acquisition for completing open capital improvement projects date			Sep. 30, 2026
Northwest Health – Starke [Member] \| Maximum
Commitments And Contingencies [Line Items]
Capital commitment, future period after acquisition for completing open capital improvement projects			5 years
Indiana [Member]
Commitments And Contingencies [Line Items]
Construction of a replacement facility			$ 15,000,000

Condensed Financial Information of Parent Company - Condensed Statements of Comprehensive (Loss) Income (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Condensed Statement Of Income Captions [Line Items]
Net (loss) income	$ 16	$ 179	$ 368
Equity in other comprehensive (loss) income of affiliates, net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax	6	(17)	(5)
Amortization and recognition of unrecognized pension cost components, net of tax	1	10	3
Other comprehensive income (loss)	7	(7)	(2)
Comprehensive (loss) income	23	172	366
Less: Comprehensive income attributable to noncontrolling interests	149	133	138
Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders	(126)	39	228
Parent Company
Condensed Statement Of Income Captions [Line Items]
Net (loss) income	(133)	46	230
Equity in other comprehensive (loss) income of affiliates, net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax	6	(17)	(5)
Amortization and recognition of unrecognized pension cost components, net of tax	1	10	3
Other comprehensive income (loss)	7	(7)	(2)
Comprehensive (loss) income	(126)	39	228
Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders	$ (126)	$ 39	$ 228

Equity Investments - Additional Information (Details) $ in Millions		12 Months Ended				84 Months Ended
	Jul. 30, 2021 USD ($) Hospital	Dec. 31, 2023 USD ($) Hospital	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2016	Dec. 31, 2023 USD ($)
Schedule Of Equity Method Investments [Line Items]
Number of hospitals sold \| Hospital		5
Proceeds from sale of unconsolidated minority equity interests				$ 110
Distribution of CoreTrust Transaction proceeds			$ 121
Gain from CoreTrust transaction			119
Equity method investment		$ 170	155			$ 170
Equity in earnings of unconsolidated affiliates		$ 8	14	$ 22
CoreTrust Holdings, LLC [Member]
Schedule Of Equity Method Investments [Line Items]
Gain from CoreTrust transaction			$ 119
Home Care [Member]
Schedule Of Equity Method Investments [Line Items]
Disposal date		Dec. 31, 2016
Percentage of ownership interest sold					80.00%	20.00%
Equity method investment ownership percentage					80.00%
HealthTrust [Member]
Schedule Of Equity Method Investments [Line Items]
Equity method investment ownership percentage		12.60%				12.60%
Two Hospitals in Macon Georgia
Schedule Of Equity Method Investments [Line Items]
Disposal date				Jul. 30, 2021
Number of hospitals sold \| Hospital	2
Percentage of ownership interest sold	38.00%
Proceeds from sale of unconsolidated minority equity interests	$ 110
Pre tax gain on sale of investments				$ 39

Acquisitions, Divestitures and Closures - Closures - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($)	Sep. 30, 2022 Item
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charge of long-lived assets sold	$ 71
Shorepoint Health Venice \| Venice, Florida
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds \| Item		312
Impairment charge of long-lived assets sold	29
First Hospital Wyoming Valley (Psychiatric) \| Wilkes-Barre, Pennsylvania
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds \| Item		149
Impairment charge of long-lived assets sold	$ 15

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Schedule of Components of Denominator for Computation of Basic and Diluted (Loss) Earnings Per Share


	Year Ended December 31,
	2023		2022		2021
Weighted-average number of shares outstanding — basic		130,445,677		128,808,387		126,754,852
Effect of dilutive securities:
Restricted stock awards		—		842,055		2,803,938
Employee stock options		—		278,057		726,130
Other equity-based awards		—		131,820		312,490
Weighted-average number of shares outstanding — diluted		130,445,677		130,060,319		130,597,410

Schedule of Antidilutive Securities


	Year Ended December 31,
	2023		2022		2021
Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:
Employee stock options and restricted stock awards		6,210,811		4,406,764		774,981

Income Taxes - Schedule of Reconciliation of the Total Amount of Unrecognized Tax Benefit (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Unrecognized tax benefit, beginning of year	$ 50	$ 42	$ 45
Gross increases — tax positions in current period	9	8	5
Reductions — tax positions in prior period	(1)		(8)
Unrecognized tax benefit, end of year	$ 58	$ 50	$ 42

Consolidated Statements of Comprehensive Income (Loss) (Parenthetical) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income (loss) [Abstract]
Net change in fair value available-for-sale debt securities, tax	$ 1	$ 5	$ 1
Amortization and recognition of unrecognized pension cost components, tax	$ 0	$ 3	$ 0

Fair Value - Schedule of Fair Value, Assets Measured on Recurring Basis (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale debt securities	$ 182	$ 179
Fair Value, Measurements, Recurring
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investments in equity securities	69	107
Available-for-sale debt securities	182	179
Trading securities	5	5
Total assets	256	291
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investments in equity securities	69	107
Total assets	69	107
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 2
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale debt securities	182	179
Trading securities	5	5
Total assets	$ 187	$ 184

Condensed Financial Information of Parent Company - Condensed Balance Sheets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
ASSETS
Prepaid income taxes	$ 76	$ 99
Total current assets	3,208	3,082
Deferred income taxes	29	49
Other assets, net	2,053	2,007
Total assets	14,455	14,669
LIABILITIES AND STOCKHOLDERS’ DEFICIT
Other long-term liabilities	739	644
Deferred income taxes	369	354
Total liabilities	15,279	15,403
Community Health Systems, Inc. stockholders’ deficit:
Common stock	1	1
Additional paid-in capital	2,185	2,084
Accumulated other comprehensive loss	(14)	(21)	$ (14)
Accumulated deficit	(3,564)	(3,431)
Total Community Health Systems, Inc. stockholders’ deficit	(1,392)	(1,367)
Total liabilities and stockholders’ deficit	14,455	14,669
Parent Company
ASSETS
Prepaid income taxes	77	99
Total current assets	77	99
Deferred income taxes	29	49
Total assets	106	148
LIABILITIES AND STOCKHOLDERS’ DEFICIT
Other long-term liabilities	46	2
Deferred income taxes	369	354
Total liabilities	1,498	1,515
Community Health Systems, Inc. stockholders’ deficit:
Common stock	1	1
Additional paid-in capital	2,185	2,084
Accumulated other comprehensive loss	(14)	(21)
Accumulated deficit	(3,564)	(3,431)
Total Community Health Systems, Inc. stockholders’ deficit	(1,392)	(1,367)
Total liabilities and stockholders’ deficit	106	148
Parent Company \| Affiliated Entity
LIABILITIES AND STOCKHOLDERS’ DEFICIT
Other long-term liabilities	$ 1,083	$ 1,159

Leases - Additional Information (Details) $ in Millions	Dec. 31, 2023 USD ($)
Leases [Abstract]
Operating lease right of use asset pending leases that have not yet commenced	$ 36

Goodwill and Other Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill

The changes in the carrying amount of goodwill for the years ended 2023 and 2022 are as follows (in millions):


Balance, beginning balance	2023			2022
Goodwill	$	6,980		$	7,033
Accumulated impairment losses		(2,814	)		(2,814	)
		4,166			4,219
Goodwill acquired as part of acquisitions during current year		23			11
Goodwill allocated to hospitals divested or held-for-sale		(231	)		(64	)

Balance, end of year
Goodwill		6,772			6,980
Accumulated impairment losses		(2,814	)		(2,814	)
	$	3,958		$	4,166

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

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-Topic 350
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
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-Subparagraph (e)
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
-Section 50
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
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-Subparagraph (g)
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

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-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1A

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-Topic 350
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

Fair Value - Net Losses and Gains Recognized for Investments in Equity Securities (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Net gains and (losses) recognized during the year on equity securities	$ 11	$ (28)	$ 20
Available-for-sale Securities
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Net gains and (losses) recognized during the year on equity securities	(5)	(2)	13
Held-to-maturity Securities
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Unrealized gains and (losses) recognized during the year on equity securities held at the end of year	$ 16	$ (26)	$ 7

Comprehensive Loss (Tables)

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Schedule of Changes in Accumulated Other Comprehensive Income (Loss) ("AOCL") by Component

The following tables present information about items reclassified out of accumulated other comprehensive loss (“AOCL”) by component for the years ended December 31, 2023 and 2022 (in millions, net of tax):


	Change in
	Fair Value of			Change in
	Available-for-Sale			Unrecognized
	Debt			Pension Cost
	Securities			Components			AOCL
Balance as of December 31, 2022	$	(19	)	$	(2	)	$	(21	)
Other comprehensive income
before reclassifications		6			1			7
Amounts reclassified from
AOCL		—			—			—
Net current-period other
comprehensive income		6			1			7
Balance as of December 31, 2023	$	(13	)	$	(1	)	$	(14	)


	Change in
	Fair Value of			Change in
	Available-for-Sale			Unrecognized
	Debt			Pension Cost
	Securities			Components			AOCL
Balance as of December 31, 2021	$	(2	)	$	(12	)	$	(14	)
Other comprehensive (loss)
income before reclassifications		(16	)		10			(6	)
Amounts reclassified from
AOCL		(1	)		—			(1	)
Net current-period other
comprehensive (loss) income		(17	)		10			(7	)
Balance as of December 31, 2022	$	(19	)	$	(2	)	$	(21	)

Long-Term Debt - Schedule of Maturities of Long-Term Debt (Details) $ in Millions	Dec. 31, 2023 USD ($)
Debt Disclosure [Abstract]
2024	$ 21
2025	12
2026	1,372
2027	2,609
2028	765
Thereafter	7,045
Total maturities	11,824
Less: Deferred debt issuance costs	(322)
Less: Unamortized note discount	(15)
Total long-term debt	$ 11,487

Long-Term Debt - 5.250% Senior Secured Notes, Due 2030 - Additional Information (Details) - Senior Secured Notes - Senior Secured Notes at 5.25%, Due 2030 - USD ($) $ in Millions		12 Months Ended
	Feb. 04, 2022	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt instrument, offering date		Feb. 04, 2022
Debt instrument aggregate principal amount	$ 1,535
Debt instrument stated interest rate	5.25%	5.25%	5.25%
Debt instrument, maturity date		May 15, 2030
Debt instrument redemption price percentage	100.00%
Debt instrument redemption description		plus a “make-whole” premium, as described in the indenture governing the 5¼% Senior Secured Notes due 2030.
Minimum period notice for redemption of debt	10 days
Maximum period notice for redemption of debt	60 days
Debt instrument, maturity year	2030	2030	2030
Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt instrument, maturity date	May 15, 2025
Debt instrument redemption price percentage	105.25%	102.625%
Debt instrument redemption description		plus accrued and unpaid interest, if any. In addition, any time prior to May 15, 2025, but not more than once during each 12 month period
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%
Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt instrument redemption price percentage	103.00%	101.313%
Debt instrument redemption description		plus accrued and unpaid interest, if any.
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	10.00%
Redeem at Any Time and from Time to Time on or After May 15, 2025
Debt Instrument [Line Items]
Debt instrument redemption description		plus accrued and unpaid interest, if any, on the 4¾% Senior Secured Notes due 2031 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on February 15 of the years indicated below:
Debt instrument, maturity year	2030
Debt instrument optional redemption date	May 15, 2025
Minimum period notice for redemption of debt	10 days
Maximum period notice for redemption of debt	60 days

Comprehensive Loss - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Reclassification, Total before tax	$ 0	$ 0

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - Employee Stock Option - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Shares	2,831,751	2,301,753	1,817,525
Granted, Shares	814,000	760,000	749,250
Exercised, Shares	(15,001)	(56,500)	(65,499)
Forfeited and cancelled, Shares		(173,502)	(199,523)
Ending Balance, Shares	3,630,750	2,831,751	2,301,753
Exercisable, Shares	2,071,994
Beginning of Period, Weighted Average Exercise Price	$ 7.32	$ 6.77	$ 8.77
Granted, Weighted Average Exercise Price	6.15	10.18	8.81
Exercised, Weighted Average Exercise Price	4.95	4.97	5.03
Forfeited and Cancelled, Weighted Average Exercise Price		13.41	33.14
End of Period, Weighted Average Exercise Price	7.07	$ 7.32	$ 6.77
Exercisable, Weighted Average Exercise Price	$ 6.46
Weighted Average Remaining Contractual Term	7 years 3 months 18 days
Exercisable, Weighted Average Remaining Contractual Term	6 years 4 months 24 days

Stockholders' Deficit - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Equity [Abstract]
Capital stock, shares authorized	400,000,000
Common stock, shares authorized	300,000,000	300,000,000
Preferred stock, shares authorized	100,000,000	100,000,000
Common stock, par value per share	$ 0.01	$ 0.01
Preferred stock, par value per share	$ 0.01	$ 0.01
Preferred stock, shares outstanding	0
Amount available for dividend payments, stock repurchases at period end	$ 300

Long-Term Debt - Schedule of Early Redemption Prices on 5.625% Senior Secured Notes Due 2027 (Details) - 5⅝% Senior Secured Notes due 2027 - Senior Secured Notes	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	102.813%
Debt Instrument, Redemption Period, Start Date	Dec. 15, 2023
Debt Instrument, Redemption Period, End Date	Dec. 14, 2024
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	101.406%
Debt Instrument, Redemption Period, Start Date	Dec. 15, 2024
Debt Instrument, Redemption Period, End Date	Dec. 14, 2025
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Dec. 15, 2025
Debt Instrument, Redemption Period, End Date	Dec. 14, 2027

Consolidated Statements of Stockholders' Deficit - USD ($) $ in Millions	Total	Redeemable Noncontrolling Interests (Non- Equity)	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Noncontrolling Interest
Equity, beginning balance at Dec. 31, 2020	$ (1,538)		$ 1	$ 2,094	$ (13)	$ (3,707)	$ 87
Redeemable Noncontrolling Interests, beginning balance at Dec. 31, 2020		$ 484
Shares, outstanding, beginning balance at Dec. 31, 2020			129,612,117
Comprehensive income (loss)	266				(2)	230	38
Comprehensive income (loss) attributable to redeemable noncontrolling interest		100
Contributions from redeemable noncontrolling interests		1
Distributions to noncontrolling interests	(39)
Distributions to redeemable noncontrolling interests		(82)					(39)
Purchase of subsidiary shares from noncontrolling interests	13	(32)		17			(4)
Other reclassifications of noncontrolling interests	1				1
Other reclassifications of redeemable noncontrolling interests		1
Disposition of less-than-wholly owned hospital		(7)
Noncontrolling interests in acquired entity		2
Adjustment to redemption value of redeemable noncontrolling interests	(13)	13		(13)
Cancellation of restricted stock for tax withholdings on vested shares	(5)			(5)
Cancellation of restricted stock for tax withholdings on vested shares, shares			(584,379)
Issuance of common stock in connection with the exercise of stock options, shares			65,499
Stock-based compensation	25			25
Stock-based compensation, shares			3,053,045
Equity, ending balance at Dec. 31, 2021	(1,290)		$ 1	2,118	(14)	(3,477)	82
Redeemable Noncontrolling Interests, ending balance at Dec. 31, 2021		480
Shares, outstanding, ending balance at Dec. 31, 2021			132,146,282
Comprehensive income (loss)	80				(7)	46
Comprehensive income (loss) attributable to redeemable noncontrolling interest		92					41
Contributions from noncontrolling interests	11
Contributions from redeemable noncontrolling interests		2					11
Distributions to noncontrolling interests	(45)
Distributions to redeemable noncontrolling interests		(80)					(45)
Purchase of subsidiary shares from noncontrolling interests	(6)	1		(6)
Noncontrolling interests in acquired entity	3	6					3
Adjustment to redemption value of redeemable noncontrolling interests	(40)	40		(40)
Cancellation of restricted stock for tax withholdings on vested shares	(8)			(8)
Cancellation of restricted stock for tax withholdings on vested shares, shares			(828,952)
Issuance of common stock in connection with the exercise of stock options, shares			56,500
Stock-based compensation	20			20
Stock-based compensation, shares			3,329,887
Equity, ending balance at Dec. 31, 2022	(1,275)		$ 1	2,084	(21)	(3,431)	92
Redeemable Noncontrolling Interests, ending balance at Dec. 31, 2022	541	541
Shares, outstanding, ending balance at Dec. 31, 2022			134,703,717
Comprehensive income (loss)	(50)				7	(133)	76
Comprehensive income (loss) attributable to redeemable noncontrolling interest		73
Contributions from noncontrolling interests	4						4
Contributions from redeemable noncontrolling interests		1
Distributions to noncontrolling interests	(69)						(69)
Distributions to redeemable noncontrolling interests		(72)
Purchase of subsidiary shares from noncontrolling interests	5	(7)		5
Other reclassifications of noncontrolling interests	263			121			142
Other reclassifications of redeemable noncontrolling interests		(266)
Noncontrolling interests in acquired entity		10
Adjustment to redemption value of redeemable noncontrolling interests	(43)	43		(43)
Cancellation of restricted stock for tax withholdings on vested shares	(4)			(4)
Cancellation of restricted stock for tax withholdings on vested shares, shares			(722,606)
Issuance of common stock in connection with the exercise of stock options, shares			15,001
Stock-based compensation	22			22
Stock-based compensation, shares			2,778,799
Equity, ending balance at Dec. 31, 2023	(1,147)		$ 1	$ 2,185	$ (14)	$ (3,564)	$ 245
Redeemable Noncontrolling Interests, ending balance at Dec. 31, 2023	$ 323	$ 323
Shares, outstanding, ending balance at Dec. 31, 2023			136,774,911

Acquisitions, Divestitures and Closures - Schedule of Balance Sheet Items Classified as Held for Sale (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Acquisitions Divestitures And Closures [Abstract]
Other current assets	$ 6	$ 6
Other assets, net	218	132
Accrued liabilities	$ (13)	$ (4)

Fair Value of Financial Instruments

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

FAIR VALUE OF FINANCIAL INSTRUMENTS

7. FAIR VALUE OF FINANCIAL INSTRUMENTS

The fair value of financial instruments has been estimated by the Company using available market information as of December 31, 2023 and 2022, and valuation methodologies considered appropriate. The estimates presented in the table below are not necessarily indicative of amounts the Company could realize in a current market exchange (in millions):


	December 31, 2023				December 31, 2022
	Carrying		Estimated Fair		Carrying		Estimated Fair
	Amount		Value		Amount		Value
Assets:
Cash and cash equivalents	$	38	$	38	$	118	$	118
Investments in equity securities		69		69		107		107
Available-for-sale debt securities		182		182		179		179
Trading securities		5		5		5		5
Liabilities:
8% Senior Secured Notes due 2026		1,109		1,114		2,083		1,917
8% Senior Secured Notes due 2027		695		679		693		631
5⅝% Senior Secured Notes due 2027		1,847		1,767		1,833		1,633
6⅞% Senior Notes due 2028		750		470		749		389
6% Senior Secured Notes due 2029		622		580		865		751
5¼% Senior Secured Notes due 2030		1,458		1,287		1,448		1,166
4¾% Senior Secured Notes due 2031		1,054		834		1,053		766
10⅞% Senior Secured Notes due 2032		982		1,047		—		—
6⅞% Junior-Priority Secured Notes due 2029		1,162		812		1,282		720
6⅛% Junior-Priority Secured Notes due 2030		1,167		781		1,164		615
ABL Facility and other debt		275		275		85		85

Cash and cash equivalents. The carrying amount approximates fair value due to the short-term maturity of these instruments (less than three months).

Investments in equity securities. Estimated fair value is based on closing price as quoted in public markets.

Available-for-sale debt securities. Estimated fair value is based on closing price as quoted in public markets or other various valuation techniques.

Trading securities. Estimated fair value is based on closing price as quoted in public markets.

Senior Notes, Senior Secured Notes and Junior-Priority Secured Notes. Estimated fair value is based on the closing market price for these notes.

ABL Facility and other debt. The carrying amount of the ABL Facility and all other debt approximates fair value due to the nature of these obligations.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Consolidated Statements of Comprehensive (Loss) Income - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income (loss) [Abstract]
Net income	$ 16	$ 179	$ 368
Other comprehensive income (loss), net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax of $1, $5 and $1 for the years ended December 31, 2023, 2022 and 2021, respectively	6	(17)	(5)
Amortization and recognition of unrecognized pension cost components, net of tax of $0, $3 and $0 for the years ended December 31, 2023, 2022 and 2021, respectively	1	10	3
Other comprehensive income (loss)	7	(7)	(2)
Comprehensive (loss) income	23	172	366
Less: Comprehensive income attributable to noncontrolling interests	149	133	138
Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders	$ (126)	$ 39	$ 228

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income (loss) and other comprehensive income (loss), attributable to noncontrolling interests. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

Amount after tax and reclassification adjustments of other comprehensive income (loss).

+ References

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The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

+ References

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+ Details

Fair Value of Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Schedule of Estimated Fair Value of Financial Instruments, by Balance Sheet Grouping


	December 31, 2023				December 31, 2022
	Carrying		Estimated Fair		Carrying		Estimated Fair
	Amount		Value		Amount		Value
Assets:
Cash and cash equivalents	$	38	$	38	$	118	$	118
Investments in equity securities		69		69		107		107
Available-for-sale debt securities		182		182		179		179
Trading securities		5		5		5		5
Liabilities:
8% Senior Secured Notes due 2026		1,109		1,114		2,083		1,917
8% Senior Secured Notes due 2027		695		679		693		631
5⅝% Senior Secured Notes due 2027		1,847		1,767		1,833		1,633
6⅞% Senior Notes due 2028		750		470		749		389
6% Senior Secured Notes due 2029		622		580		865		751
5¼% Senior Secured Notes due 2030		1,458		1,287		1,448		1,166
4¾% Senior Secured Notes due 2031		1,054		834		1,053		766
10⅞% Senior Secured Notes due 2032		982		1,047		—		—
6⅞% Junior-Priority Secured Notes due 2029		1,162		812		1,282		720
6⅛% Junior-Priority Secured Notes due 2030		1,167		781		1,164		615
ABL Facility and other debt		275		275		85		85

Acquisitions, Divestitures and Closures

12 Months Ended

Dec. 31, 2023

Acquisitions Divestitures And Closures [Abstract]

ACQUISITIONS, DIVESTITURES AND CLOSURES

3. ACQUISITIONS, DIVESTITURES AND CLOSURES

Acquisitions

During the years ended December 31, 2023, 2022 and 2021, one or more subsidiaries of the Company paid approximately $38 million, $9 million and $3 million, respectively, to acquire the operating assets and related businesses of certain physician practices, clinics, ambulatory surgery centers and other ancillary businesses that operate within the communities served by the Company’s affiliated hospitals. During the year ended December 31, 2023, a majority of the amount paid related to the Company's purchase of certain assets from American Physician Partners (“APP”) for approximately $20 million. This transaction, which resulted in the Company recording a definite-lived intangible asset for the acquisition of an assembled workforce, was accounted for as an asset acquisition. In connection with these acquisitions, inclusive of APP, the Company allocated the purchase price to property and equipment, working capital, intangible assets, noncontrolling interests and goodwill.

Divestitures

The following table provides a summary of hospitals that the Company divested (or, in the case of Lutheran Rehabilitation Hospital, in which the Company sold a majority interest) during the years ended December 31, 2023, 2022 and 2021.


Hospital	Buyer	City, State	Licensed Beds	Effective Date
2023 Divestitures:
Greenbrier Valley Medical Center	Vandalia Health, Inc.	Ronceverte, WV	122	January 1, 2023
Plateau Medical Center	Vandalia Health, Inc.	Oak Hill, WV	25	April 1, 2023
Medical Center of South Arkansas	SARH Holdings, Inc.	El Dorado, AR	166	July 1, 2023
Lutheran Rehabilitation Hospital	Select Medical Corporation	Fort Wayne, IN	36	September 1, 2023
AllianceHealth Ponca City	Integris Health	Ponca City, OK	140	November 1, 2023
AllianceHealth Woodward	Integris Health	Woodward, OK	87	November 1, 2023
Bravera Health Brooksville	Tampa General Hospital	Brooksville, FL	120	December 1, 2023
Bravera Health Spring Hill	Tampa General Hospital	Spring Hill, FL	124	December 1, 2023
Bravera Health Seven Rivers	Tampa General Hospital	Crystal River, FL	128	December 1, 2023

2022 Divestitures:
AllianceHealth Seminole	SSM Health Care of Oklahoma, Inc.	Seminole, OK	32	July 1, 2022

2021 Divestitures:
Lea Regional Medical Center	Covenant Health System	Hobbs, NM	84	January 1, 2021
Tennova Healthcare - Tullahoma	Vanderbilt University Medical Center	Tullahoma, TN	135	January 1, 2021
Tennova Healthcare - Shelbyville	Vanderbilt University Medical Center	Shelbyville, TN	60	January 1, 2021
Northwest Mississippi Medical Center	Delta Health System	Clarksdale, MS	181	February 1, 2021
AllianceHealth Midwest	SSM Health Care of Oklahoma, Inc.	Midwest City, OK	255	April 1, 2021

On February 28, 2023, the Company entered into a definitive agreement for the sale of substantially all of the assets of Lake Norman Regional Medical Center (123 licensed beds) in Mooresville, North Carolina, and Davis Regional Medical Center (144 licensed beds) in Statesville, North Carolina, to Novant Health, Inc. In January 2024, the Federal Trade Commission filed a Complaint for Temporary Restraining Order and Preliminary Injunction seeking to enjoin the consummation of the aforementioned sale of Lake Norman Regional Medical Center and Davis Regional Medical Center to Novant Health, Inc. An administrative merits hearing on such matter is scheduled for April 29, 2024. These hospitals were classified as held-for-sale as of December 31, 2023.

The following table discloses amounts included in the consolidated balance sheet for hospitals and other assets classified as held-for-sale as of December 31, 2023 and 2022 (in millions). Other assets, net primarily includes goodwill and the net property and equipment for hospitals held-for-sale. No hospitals were classified as held-for-sale as of December 31, 2021 and no divestitures or potential divestitures meet the criteria for reporting as a discontinued operation as of December 31, 2023, 2022, or 2021.


	December 31,
	2023			2022
Other current assets	$	6		$	6
Other assets, net		218			132
Accrued liabilities		(13	)		(4	)

Closures

During the three months ended September 30, 2022, the Company completed the closure of Shorepoint Health Venice hospital (312 licensed beds) in Venice, Florida. The Company recorded an impairment charge of approximately $29 million during the year ended December 31, 2022, to adjust the fair value of the long-lived assets of this hospital, including property and equipment and capitalized software costs, based on their estimated fair value.

During the three months ended September 30, 2022, the provision of inpatient services and substantially all outpatient services ceased at First Hospital Wyoming Valley (psychiatric hospital) (149 licensed beds) in Wilkes-Barre, Pennsylvania, resulting in the closure of this facility being substantially complete as of September 30, 2022. The Company completed the closure of First Hospital Wyoming Valley during the three months ended December 31, 2022. The Company recorded an impairment charge of approximately $15 million during the year ended December 31, 2022, to adjust the fair value of the long-lived assets of this hospital, including property and equipment and capitalized software costs, based on their estimated fair value.

Other

On December 31, 2022, the lease for AllianceHealth Clinton (56 licensed beds) in Clinton, Oklahoma, expired and was not renewed. The Company recorded an impairment charge of approximately $1 million during the year ended December 31, 2022 in conjunction with exiting the lease to operate this hospital.

Long-Term Debt

12 Months Ended

Dec. 31, 2023

Long-Term Debt and Lease Obligation [Abstract]

LONG-TERM DEBT

6. LONG-TERM DEBT

Long-term debt, net of unamortized debt issuance costs and discounts or premiums, consists of the following (in millions):


	December 31,
	2023			2022
8% Senior Secured Notes due 2026	$	1,116		$	2,101
8% Senior Secured Notes due 2027		700			700
5⅝% Senior Secured Notes due 2027		1,900			1,900
6⅞% Senior Notes due 2028		756			756
6% Senior Secured Notes due 2029		644			900
5¼% Senior Secured Notes due 2030		1,535			1,535
4¾% Senior Secured Notes due 2031		1,058			1,058
10⅞% Senior Secured Notes due 2032		1,000			—
6⅞% Junior-Priority Secured Notes due 2029		1,244			1,386
6⅛% Junior-Priority Secured Notes due 2030		1,227			1,232
ABL Facility		247			53
Finance lease and financing obligations		366			380
Other		32			36
Less: Unamortized deferred debt issuance costs and note discount		(338	)		(402	)
Total debt		11,487			11,635
Less: Current maturities		(21	)		(21	)
Total long-term debt	$	11,466		$	11,614

8% Senior Secured Notes due 2026

On March 6, 2019, CHS/Community Health Systems, Inc. (“CHS”) completed a private offering of $1.601 billion aggregate principal amount of the 8% Senior Secured Notes due March 15, 2026 (the “8% Senior Secured Notes due 2026”). The net proceeds from this issuance were used to finance the repayment of approximately $1.557 billion aggregate principal amount of CHS’ then outstanding Term H Facility and related fees and expenses. On November 19, 2019, CHS completed a tack-on offering of $500 million aggregate principal amount of the additional 2026 Notes, increasing the total aggregate principal amount of the 8% Senior Secured Notes due 2026 to $2.101 billion. CHS used the proceeds from the additional 2026 Notes to repay amounts outstanding under the ABL Facility and redeem all $121 million aggregate principal amount of CHS’ then outstanding 7⅛% Senior Notes due 2020. The additional 2026 Notes have identical terms, other than issue date, issue price and the date from which interest initially accrued, as the 8% Senior Secured Notes due 2026 issued on March 6, 2019. The 8% Senior Secured Notes due 2026 bear interest at a rate of 8.000% per annum, payable semi-annually in arrears on March 15 and September 15 of each year. Interest on the 8% Senior Secured Notes due 2026 accrues from the initial issuance date of the 8% Senior Secured Notes due 2026. Interest is calculated on the basis of a 360-day year comprised of 12 30-day months. The 8% Senior Secured Notes due 2026 are scheduled to mature on March 15, 2026. The 8% Senior Secured Notes due 2026 are unconditionally guaranteed on a senior-priority secured basis by the Company and each of the CHS current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS᾿ outstanding senior notes) and certain other long-term debt of CHS.

The 8% Senior Secured Notes due 2026 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 8% Senior Secured Notes due 2026.

After March 15, 2022, CHS is entitled, at its option, to redeem all or a portion of the 8% Senior Secured Notes due 2026 upon not less than 15 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:


Period	Redemption Price
March 15, 2023 to March 14, 2024		102.000	%
March 15, 2024 to March 14, 2026		100.000	%

8% Senior Secured Notes due 2027

On November 19, 2019, CHS issued approximately $700 million aggregate principal amount of the 8% Senior Secured Notes due December 15, 2027 (the “8% Senior Secured Notes due 2027”) in connection with the 2019 Exchange Offer. No cash proceeds were received from the 2019 Exchange Offer. The 8% Senior Secured Notes due 2027 bear interest at a rate of 8.000% per annum, payable semi-annually in arrears on June 15 and December 15 of each year. Interest on the 8% Senior Secured Notes due 2027 accrues from the initial issuance date of the 8% Senior Secured Notes due 2027. Interest is calculated on the basis of a 360-day year comprised of 12 30-day months. The 8% Senior Secured Notes due 2027 are scheduled to mature on December 15, 2027. The 8% Senior Secured Notes due 2027 are unconditionally guaranteed on a senior-priority secured basis by the Company and each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS᾿ outstanding senior notes) and certain other long-term debt of CHS.

The 8% Senior Secured Notes due 2027 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 8% Senior Secured Notes due 2027.

CHS may redeem some or all of the 8% Senior Secured Notes due 2027 at any time on or after December 15, 2022 upon not less than 15 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:


Period	Redemption Price
December 15, 2023 to December 14, 2024		102.000	%
December 15, 2024 to December 14, 2027		100.000	%

5⅝% Senior Secured Notes due 2027

On December 28, 2020, CHS completed a private offering of $1.9 billion aggregate principal amount of 5⅝% Senior Secured Notes due March 15, 2027 (the “5⅝% Senior Secured Notes due 2027”). The proceeds of the offering were used to repurchase approximately $2.579 billion of the outstanding principal amount of 6¼% Senior Secured Notes due 2023 that were validly tendered and accepted for purchase pursuant to the early tender deadline of a tender offer that launched on December 11, 2020, and to pay related fees. The remaining principal value of 6¼% Senior Secured Notes due 2023 that were not validly tendered as of the early tender deadline were redeemed or repurchased via the completion of the tender offer on January 11, 2021 or redemption on January, 28, 2021. The 5⅝% Senior Secured Notes due 2027, which mature on March 15, 2027, bear interest at a rate of 5⅝% per year payable semi-annually in arrears on March 15 and September 15 of each year, commencing on September 15, 2021. The 5⅝% Senior Secured Notes due 2027 are unconditionally guaranteed on a senior-priority secured basis by the Company and each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 5⅝% Senior Secured Notes due 2027 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 5⅝% Senior Secured Notes due 2027.

At any time and from time to time on or after December 15, 2023, CHS may redeem the 5⅝% Senior Secured Notes due 2027 in whole or in part, upon not less than 15 no more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 5⅝% Senior Secured Notes due 2027 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on December 15 of the years indicated below:


Period	Redemption Price
December 15, 2023 to December 14, 2024		102.813	%
December 15, 2024 to December 14, 2025		101.406	%
December 15, 2025 to December 14, 2027		100.000	%

6⅞% Senior Notes due 2028

On November 19, 2019, CHS issued approximately $1.7 billion aggregate principal amount of the 6⅞% Senior Notes due April 1, 2028 (“the 6⅞% Senior Notes due 2028”) in connection with the 2019 Exchange Offer. No cash proceeds were received in the 2019 Exchange Offer. The 6⅞% Senior Notes due 2028 bear interest at a rate of 6.875% per annum, payable semi-annually in arrears on April 1 and October 1 of each year. Interest on the 6⅞% Senior 2028 Notes accrues from the initial issuance date of the 6⅞% Senior Notes due 2028. Interest is calculated on the basis of a 360-day year comprised of 12 30-day months. The 6⅞% Senior Notes due 2028 are scheduled to mature on April 1, 2028. The 6⅞% Senior Notes due 2028 are unconditionally guaranteed on a senior-priority unsecured basis by the Company and each of the CHS current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS᾿ outstanding senior notes) and certain other long-term debt of CHS.

CHS may redeem some or all of the 6⅞% Senior Notes due 2028 at any time on or after April 1, 2023 upon not less than 15 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:


Period	Redemption Price
April 1, 2023 to March 31, 2024		103.438	%
April 1, 2024 to March 31, 2025		101.719	%
April 1, 2025 to March 31, 2028		100.000	%

On December 7, 2020, CHS entered into a privately negotiated agreement with a multi-asset investment manager who has certain funds and accounts which are holders of the 6⅞% Senior Notes due 2028. Pursuant to the agreement, the Company exchanged $700 million aggregate principal amount of the 6⅞% Senior Notes due 2028 for an aggregate consideration of $400 million of cash and 10 million newly issued shares of the Company’s common stock. The exchange transaction was completed on December 9, 2020 and the shares of common stock issued in the exchange were not, and are not required to be, registered under the Securities Act of 1933 pursuant to an exemption from registration provisions via Section 3(a)(9) of the Securities Act of 1933. A gain from early extinguishment of debt of approximately $205 million was recognized associated with this exchange.

During the year ended December 31, 2020, the Company extinguished $226 million in principal of the 6⅞% Senior Notes due 2028 through open market repurchases and approximately $7 million via a tender offer that commenced on October 30, 2020 and expired on November 30, 2020.

6% Senior Secured Notes due 2029

On December 28, 2020, CHS completed a private offering of $900 million aggregate principal amount of 6% Senior Secured Notes due January 15, 2029 (the “6% Senior Secured Notes due 2029”). The proceeds of the offering were used, together with proceeds from the 5⅝% Senior Secured Notes due 2027 described above, to repurchase approximately $2.579 billion of the outstanding principal amount of 6¼% Senior Secured Notes due 2023 that were validly tendered and accepted for purchase pursuant to the early tender deadline of a tender offer that launched on December 11, 2020, and to pay related fees. The remaining principal value of 6¼% Senior Secured Notes due 2023 that were not validly tendered as of the early tender deadline were redeemed or repurchased via the completion of the tender offer on January 11, 2021 or redemption on January, 28, 2021. The 6% Senior Secured Notes due 2029, which mature on January 15, 2029, bear interest at a rate of 6% per year payable semi-annually in arrears on January 15 and July 15 of each year, commencing on July 15, 2021. The 6% Senior Secured Notes due 2029 are unconditionally guaranteed on a senior-priority secured basis by each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 6% Senior Secured Notes due 2029 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 6% Senior Secured Notes due 2029.

CHS is entitled, at its option, to redeem all or a portion of the 6% Senior Secured Notes due 2029 at any time prior to January 15, 2024, upon not less than 15 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 6% Senior Secured Notes due 2029 redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 6% Senior Secured Notes due 2029.

CHS may redeem up to 40% of the aggregate principal amount of the 6% Senior Secured Notes due 2029 at any time prior to January 15, 2024 using the net proceeds from certain equity offerings at the redemption price of 106.000% of the principal amount of the 6% Senior Secured Notes due 2029 redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after January 15, 2024, CHS may redeem the 6% Senior Secured Notes due 2029 in whole or in part, upon not less than 15 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 6% Senior Secured Notes due 2029 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on January 15 of the years indicated below:


Period	Redemption Price
January 15, 2024 to January 14, 2025		103.000	%
January 15, 2025 to January 14, 2026		101.500	%
January 15, 2026 to January14, 2029		100.000	%

5¼% Senior Secured Notes due 2030

On February 4, 2022, CHS completed a private offering of $1.535 billion aggregate principal amount of 5¼% Senior Secured Notes due May 15, 2030 (the “5¼% Senior Secured Notes due 2030”). The proceeds of the offering were used to redeem the 6⅝% Senior Secured Notes due 2025 on February 4, 2022, and to pay related fees and expenses. The 5¼% Senior Secured Notes due 2030 bear interest at a rate of 5.250% per year payable semi-annually in arrears on May 15 and November 15, commencing on November 15, 2022. The 5¼% Senior Secured Notes due 2030 are unconditionally guaranteed on a senior-priority secured basis by each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 5¼% Senior Secured Notes due 2030 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 5¼% Senior Secured Notes due 2030.

CHS is entitled, at its option, to redeem all or a portion of the 5¼% Senior Secured Notes due 2030 at any time prior to May 15, 2025, upon not less than 10 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 5¼% Senior Secured Notes due 2030 redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 5¼% Senior Secured Notes due 2030.

CHS may redeem up to 40% of the aggregate principal amount of the 5¼% Senior Secured Notes due 2030 at any time prior to May 15, 2025 using the net proceeds from certain equity offerings at a redemption price of 105.250% of the principal amount of the 5¼% Senior Secured Notes due 2030 redeemed, plus accrued and unpaid interest, if any. In addition, any time prior to May 15, 2025, but not more than once during each 12 month period, CHS may redeem up to 10% of the original aggregate principal amount of the 5¼% Senior Secured Notes due 2030 at a redemption price equal to 103% of the principal amount of the 5¼% Senior Secured Notes due 2030 to be redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after May 15, 2025, CHS may redeem the 5¼% Senior Secured Notes due 2030 in whole or in part, upon not less than 10 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 5¼% Senior Secured Notes due 2030 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on May 15 of the years indicated below:


Period	Redemption Price
May 15, 2025 to May 14, 2026		102.625	%
May 15, 2026 to May 14, 2027		101.313	%
May 15, 2027 to May 14, 2030		100.000	%

4¾% Senior Secured Notes due 2031

On February 9, 2021, CHS completed a private offering of $1.095 billion aggregate principal amount of 4¾% Senior Secured Notes due February 15, 2031 (the “4¾% Senior Secured Notes due 2031”). The proceeds of the offering, together with cash on hand, were used to redeem the 8⅝% Senior Secured Notes due 2024 on February 9, 2021, and to pay related fees and expenses. The 4¾% Senior Secured Notes due 2031 bear interest at a rate of 4.750% per year payable semi-annually in arrears on February 15 and August 15, commencing on August 15, 2021. The 4¾% Senior Secured Notes due 2031 are unconditionally guaranteed on a senior-priority secured basis by each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 4¾% Senior Secured Notes due 2031 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 4¾% Senior Secured Notes due 2031.

CHS is entitled, at its option, to redeem all or a portion of the 4¾% Senior Secured Notes due 2031 at any time prior to February 15, 2026, upon not less than 15 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 4¾% Senior Secured Notes due 2031 redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 4¾% Senior Secured Notes due 2031.

CHS may redeem up to 40% of the aggregate principal amount of the 4¾% Senior Secured Notes due 2031 at any time prior to February 15, 2024 using the net proceeds from certain equity offerings at a redemption price of 104.750% of the principal amount of the 4¾% Senior Secured Notes due 2031 redeemed, plus accrued and unpaid interest, if any. In addition, any time prior to February 15, 2026, but not more than once during each 12 month period, CHS may redeem up to 10% of the original aggregate principal amount of the 4¾% Senior Secured Notes due 2031 at a redemption price equal to 103% of the principal amount of the 4¾% Senior Secured Notes due 2031 to be redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after February 15, 2026, CHS may redeem the 4¾% Senior Secured Notes due 2031 in whole or in part, upon not less than 15 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 4¾% Senior Secured Notes due 2031 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on February 15 of the years indicated below:


Period	Redemption Price
February 15, 2026 to February 14, 2027		102.375	%
February 15, 2027 to February 14, 2028		101.583	%
February 15, 2028 to February 14, 2029		100.792	%
February 15, 2029 to February 14, 2031		100.000	%

10⅞% Senior Secured Notes due 2032

On December 22, 2023, CHS completed a private offering of $1.000 billion aggregate principal amount of 10⅞% Senior Secured Notes due January 15, 2032 (the “10⅞% Senior Secured Notes due 2032”). The proceeds of the offering, together with cash on hand, were used to redeem $985 million aggregate principal value of the 8% Senior Secured Notes due 2026 on December 28, 2023, and to pay related fees and expenses. The 10⅞% Senior Secured Notes due 2032 bear interest at a rate of 10.875% per year payable semi-annually in arrears on February 15 and August 15, commencing on August 15, 2024. The 10⅞% Senior Secured Notes due 2032 are unconditionally guaranteed on a senior-priority secured basis by the Company and each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 10⅞% Senior Secured Notes due 2032 and the related guarantees are secured by shared (i) first-priority liens on the Non-ABL Priority Collateral and (ii) second-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 10⅞% Senior Secured Notes due 2032.

CHS is entitled, at its option, to redeem all or a portion of the 10⅞% Senior Secured Notes due 2032 at any time prior to February 15, 2027, upon not less than 10 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 10⅞% Senior Secured Notes due 2032 redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 10⅞% Senior Secured Notes due 2032.

CHS may redeem up to 40% of the aggregate principal amount of the 10⅞% Senior Secured Notes due 2032 at any time prior to February 15, 2027 using the net proceeds from certain equity offerings at a redemption price of 110.875% of the principal amount of the 10⅞% Senior Secured Notes due 2032 redeemed, plus accrued and unpaid interest, if any. In addition, any time prior to February 15, 2027, but not more than once during each 12 month period, CHS may redeem up to 10% of the original aggregate principal amount of the 10⅞% Senior Secured Notes due 2032 at a redemption price equal to 103% of the principal amount of the 10⅞% Senior Secured Notes due 2032 to be redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after February 15, 2027, CHS may redeem the 10⅞% Senior Secured Notes due 2032 in whole or in part, upon not less than 10 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 10⅞% Senior Secured Notes due 2032 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on February 15 of the years indicated below:


Period	Redemption Price
February 15, 2027 to February 14, 2028		105.438	%
February 15, 2028 to February 14, 2029		102.719	%
February 15, 2029 to January 14, 2032		100.000	%

6⅞% Junior-Priority Secured Notes due 2029

On February 2, 2021, CHS completed a private offering of $1.775 billion aggregate principal amount of 6⅞% Junior-Priority Secured Notes due April 15, 2029 (the “6⅞% Junior-Priority Secured Notes due 2029”). The proceeds of the offering, together with cash on hand, were used to redeem the 9⅞% Junior-Priority Secured Notes due 2023 in February 2021 and to pay related fees and expenses. The 6⅞% Junior-Priority Secured Notes due 2029 bear interest at a rate of 6.875% per year payable semi-annually in arrears on April 15 and October 15 of each year, commencing on October 15, 2021. The 6⅞% Junior-Priority Secured Notes due 2029 are unconditionally guaranteed on a junior-priority secured basis by the Company and each of the current and future domestic subsidiaries of CHS that provide guarantees under CHS’ ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 6⅞% Junior-Priority Secured Notes due 2029 and the related guarantees are secured by shared (i) second-priority liens on the Non-ABL Priority Collateral that secures on a first-priority basis CHS’ senior-priority secured notes and (ii) third-priority liens on the ABL-Priority Collateral that secures on a first-priority basis the ABL Facility (and also secures on a second-priority basis CHS’ senior-priority secured notes), in each case subject to permitted liens described in the indenture governing the 6⅞% Junior-Priority Secured Notes due 2029.

At any time and from time to time prior to April 15, 2024, CHS may redeem the 6⅞% Junior-Priority Secured Notes due 2029 in whole or in part, at its option, upon not less than 15 nor more than 60 days’ prior written notice at a redemption price equal to 100% of the principal amount of the 6⅞% Junior-Priority Secured Notes due 2029 to be redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 6⅞% Junior-Priority Secured Notes due 2029.

CHS may redeem up to 40% of the aggregate principal amount of the 6⅞% Junior-Priority Secured Notes due 2029 at any time prior to April 15, 2024 using the net proceeds from certain equity offerings at a redemption price of 106.875% of the principal amount of the 6⅞% Junior-Priority Secured Notes due 2029 redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after April 15, 2024, CHS may redeem the 6⅞% Junior-Priority Secured Notes due 2029 in whole or in part, upon not less than 15 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 6⅞% Junior-Priority Secured Notes due 2029 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on April 15 of the years indicated below:


Period	Redemption Price
April 15, 2024 to April 14, 2025		103.438	%
April 15, 2025 to April 14, 2026		101.719	%
April 15, 2026 to April 14, 2029		100.000	%

6⅛% Junior-Priority Secured Notes due 2030

On May 19, 2021, CHS completed a private offering of $1.440 billion aggregate principal amount of 6⅛% Junior-Priority Secured Notes due April 1, 2030 (the “6⅛% Junior-Priority Secured Notes due 2030”). The proceeds of the offering, together with cash on hand, were used to redeem the 8⅛% Junior-Priority Secured Notes due 2024 on May 19, 2021, and to pay related fees and expenses. The 6⅛% Junior-Priority Secured Notes due 2030 bear interest at a rate of 6.125% per year payable semi-annually in arrears on April 1 and October 1, commencing on October 1, 2021. The 6⅛% Junior-Priority Secured Notes due 2030 are unconditionally guaranteed on a junior-priority secured basis by each of CHS’ current and future domestic subsidiaries that provide guarantees under the ABL Facility, any capital market debt securities of CHS (including CHS’ outstanding senior notes) and certain other long-term debt of CHS.

The 6⅛% Junior-Priority Secured Notes due 2030 and the related guarantees are secured by shared (i) second-priority liens on the Non-ABL Priority Collateral and (ii) third-priority liens on the ABL Priority Collateral that secures on a first-priority basis the ABL Facility, in each case subject to permitted liens described in the indenture governing the 6⅛% Junior-Priority Secured Notes due 2030.

CHS is entitled, at its option, to redeem all or a portion of the 6⅛% Junior-Priority Secured Notes due 2030 at any time prior to April 1, 2025, upon not less than 15 nor more than 60 days’ notice, at a price equal to 100% of the principal amount of the 6⅛% Junior-Priority Secured Notes due 2030 redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the indenture governing the 6⅛% Junior-Priority Secured Notes due 2030.

CHS may redeem up to 40% of the aggregate principal amount of the 6⅛% Junior-Priority Secured Notes due 2030 at any time prior to May 15, 2024 using the net proceeds from certain equity offerings at a redemption price of 106.125% of the principal amount of the 6⅛% Junior-Priority Secured Notes due 2030 redeemed, plus accrued and unpaid interest, if any.

At any time and from time to time on or after April 1, 2025, CHS may redeem the 6⅛% Junior-Priority Secured Notes due 2030 in whole or in part, upon not less than 15 nor more than 60 days’ prior written notice at a redemption price equal to the percentage of principal amount set forth below plus accrued and unpaid interest, if any, on the 6⅛% Junior-Priority Secured Notes due 2030 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on April 1 of the years indicated below:


Period	Redemption Price
April 1, 2025 to March 31, 2026		103.063	%
April 1, 2026 to March 31, 2027		101.531	%
April 1, 2027 to March 31, 2030		100.000	%

During the years ended December 31, 2023 and 2022, the Company extinguished a portion of certain series of its outstanding notes through open market repurchases, and privately negotiated repurchases with a limited number of holders, as follows (in millions):


	December 31,
	2023		2022
6⅞% Senior Notes due 2028	$	—	$	11
6% Senior Secured Notes due 2029		256		—
4¾% Senior Secured Notes due 2031		—		37
6⅞% Junior-Priority Secured Notes due 2029		142		389
6⅛% Junior-Priority Secured Notes due 2030		4		208
Total principal amount of debt extinguished	$	402	$	645

Financing and repayment transactions discussed above, including open market and privately negotiated repurchases, resulted in a pre-tax and after-tax gain from early extinguishment of debt of $72 million and $61 million, respectively, for the year ended December 31, 2023, a pre-tax and after-tax gain from early extinguishment of debt of $253 million and $208 million, respectively, for the year ended December 31, 2022, a pre-tax and after-tax loss from early extinguishment of $79 million and $116 million, respectively, for the year ended December 31, 2021.

ABL Facility

On November 22, 2021, the Company and CHS entered into an amendment and restatement agreement (the “Amendment”) to refinance and replace the asset-based loan (ABL) credit agreement (the “ABL Credit Agreement” and, as amended by the Amendment, the “Amended and Restated ABL Credit Agreement”), dated as of April 3, 2018, with JPMorgan Chase Bank, N.A., as administrative agent, and the lenders and other agents party thereto. Pursuant to the Amended and Restated ABL Credit Agreement, the lenders have extended to CHS a revolving asset-based loan facility in the maximum aggregate principal amount of $1.0 billion, subject to borrowing base capacity. The ABL Facility includes borrowing capacity available for letters of credit of $200 million. CHS and all domestic subsidiaries of CHS that guarantee CHS’ other outstanding senior and senior secured indebtedness guarantee the obligations of CHS under the ABL Facility. Subject to certain exceptions, all obligations under the ABL Facility and the related guarantees are secured by a perfected first-priority security interest in substantially all of the receivables, deposit, collection and other accounts and contract rights, books, records and other instruments related to the foregoing of the Company, CHS and the guarantors, as well as a perfected junior-priority security interest in substantially all of the other assets of the Company, CHS and the guarantors, subject to customary exceptions and intercreditor arrangements. At December 31, 2023, the Company had outstanding borrowings of $247 million and approximately $637 million of additional borrowing capacity (after taking into consideration the $81 million of outstanding letters of credit) under the ABL Facility. The issued letters of credit were primarily in support of potential insurance-related claims and certain bonds.

Borrowings under the ABL Facility bear interest at a rate per annum equal to an applicable percentage, plus, at the borrower’s option, either (a) a base rate or (b) the Federal Reserve’s secured overnight financing rate (“SOFR”). The applicable margin under the ABL Facility is determined based on excess availability as a percentage of the maximum commitment amount under the ABL Facility at a rate per annum of 0.75%, 1.00% and 1.25% for loans based on the base rate and 1.75%, 2.00% and 2.25% for loans based on SOFR. The applicable commitment fee rate under the ABL Facility is determined based on average utilization as a percentage of the maximum commitment amount under the ABL Facility at a rate per annum of either 0.25% or 0.375% times the unused portion of the ABL Facility.

Principal amounts outstanding under the ABL Facility will be due and payable in full on November 22, 2026. The ABL Facility includes a 91-day springing maturity applicable if more than $350 million in the aggregate principal amount of the 8% Senior Secured Notes due 2026, 5⅝% Senior Secured Notes due 2027 or any indebtedness incurred to refinance the foregoing are scheduled to mature or similarly become due on a date prior to November 22, 2026. In such event, principal amounts outstanding under the ABL Facility will be accelerated and all amounts outstanding under the ABL Facility will become immediately due and payable.

The ABL Facility contains customary representations and warranties, subject to limitations and exceptions, and customary covenants restricting the Company’s ability, subject to certain exceptions, to, among other things (1) declare dividends, make distributions or redeem or repurchase capital stock, (2) prepay, redeem or repurchase other debt, (3) incur liens or grant negative pledges, (4) make loans and investments and enter into acquisitions and joint ventures, (5) incur additional indebtedness or provide certain guarantees, (6) engage in mergers, acquisitions and asset sales, (7) conduct transactions with affiliates, (8) alter the nature of the Company’s, CHS’ or the guarantors’ businesses, (9) grant certain guarantees with respect to physician practices, (10) engage in

sale and leaseback transactions or (11) change the Company’s fiscal year. The Company is also required to comply with a consolidated fixed coverage ratio, upon certain triggering events described below, and various affirmative covenants. The consolidated fixed coverage ratio is calculated as the ratio of (x) consolidated EBITDA (as defined in the ABL Facility) less capital expenditures to (y) the sum of consolidated interest expense (as defined in the ABL Facility), scheduled principal payments, income taxes and restricted payments made in cash or in permitted investments. For purposes of calculating the consolidated fixed charge coverage ratio, the calculation of consolidated EBITDA as defined in the ABL Facility is a trailing 12-month calculation that begins with the Company’s consolidated net income, with certain adjustments for interest, taxes, depreciation and amortization, net income attributable to noncontrolling interests, stock compensation expense, restructuring costs, and the financial impact of other non-cash or non-recurring items recorded during any such 12-month period. The consolidated fixed charge coverage ratio is a required covenant only in periods where the total borrowings outstanding under the ABL Facility reduce the amount available in the facility to less than the greater of (i) $95 million or (ii) 10% of the calculated borrowing base. As a result, in the event the Company has less than $95 million available under the ABL Facility, the Company would need to comply with the consolidated fixed charge coverage ratio. At December 31, 2023, the Company is not subject to the consolidated fixed charge coverage ratio as such triggering event had not occurred during the year ended December 31, 2023.

In addition, in the event the amount of borrowings and letters of credit outstanding at any time under the ABL Facility exceeds the borrowing base at such time, the Company will be required to, first, repay outstanding borrowings and, second, replace or cash collateralize outstanding letters of credit, in an aggregate amount sufficient to eliminate such excess.

Events of default under the ABL Facility include, but are not limited to, (1) CHS’ failure to pay principal, interest, fees or other amounts under the ABL Facility Agreement when due (taking into account any applicable grace period), (2) any representation or warranty proving to have been materially incorrect when made, (3) covenant defaults subject, with respect to certain covenants, to an available cure and applicable grace periods, (4) bankruptcy and insolvency events, (5) a cross default to certain other debt, (6) certain undischarged judgments (not paid within an applicable grace period), (7) a change of control (as defined), (8) certain ERISA-related defaults and (9) the invalidity or impairment of specified security interests, guarantees or subordination provisions in favor of the ABL agent or lenders under the ABL Facility.

As of December 31, 2023, the scheduled maturities of long-term debt outstanding, including finance lease and financing obligations for each of the next five years and thereafter are as follows (in millions):


Year Ending December 31,	Amount
2024	$	21
2025		12
2026		1,372
2027		2,609
2028		765
Thereafter		7,045
Total maturities		11,824
Less: Deferred debt issuance costs		(322	)
Less: Unamortized note discount		(15	)
Total long-term debt	$	11,487

The Company paid interest of $801 million, $835 million and approximately $778 million on borrowings during the years ended December 31, 2023, 2022 and 2021, respectively.

Accounting for Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

Schedule of Share-based Compensation Expense

The following table reflects the impact of total compensation expense related to stock-based equity plans on the reported operating results for the respective periods (in millions):


	Year Ended December 31,
	2023			2022			2021
Effect on income before income taxes	$	(22	)	$	(20	)	$	(25	)
Effect on net income	$	(17	)	$	(15	)	$	(20	)

Schedule of Share-based Payment Awards, Stock Options, Valuation Assumptions


	Year Ended December 31,
	2023		2022		2021
Expected volatility	87.3%		84.3% - 87.5%		84.3% - 88.9%
Expected dividends		—		—		—
Expected term	6 years		3 - 6 years		3 - 6 years
Risk-free interest rate	4.2%		1.5% - 1.6%		0.3% - 0.9%

Schedule of Share-based Compensation, Stock Options, Activity


	Shares			Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term	Aggregate Intrinsic Value as of December 31, 2023
Outstanding at December 31, 2020		1,817,525		$	8.77
Granted		749,250			8.81
Exercised		(65,499	)		5.03
Forfeited and cancelled		(199,523	)		33.14
Outstanding at December 31, 2021		2,301,753			6.77
Granted		760,000			10.18
Exercised		(56,500	)		4.97
Forfeited and cancelled		(173,502	)		13.41
Outstanding at December 31, 2022		2,831,751			7.32
Granted		814,000			6.15
Exercised		(15,001	)		4.95
Forfeited and cancelled		—			—
Outstanding at December 31, 2023		3,630,750		$	7.07	7.3 years	$	—
Exercisable at December 31, 2023		2,071,994		$	6.46	6.4 years	$	—

Schedule of Share-based Compensation, Restricted Stock, Activity

Restricted stock outstanding under the 2009 Plan as of December 31, 2023, and changes during each of the years in the three-year period prior to December 31, 2023, were as follows:


	Shares			Weighted- Average Grant Date Fair Value
Unvested at December 31, 2020		4,555,735		$	4.84
Granted		2,929,250			8.16
Vested		(2,312,328	)		4.68
Forfeited		(177,343	)		6.33
Unvested at December 31, 2021		4,995,314			6.30
Granted		3,253,000			8.95
Vested		(2,561,575	)		5.70
Forfeited		(145,674	)		8.89
Unvested at December 31, 2022		5,541,065			8.53
Granted		2,746,000			6.04
Vested		(2,164,570	)		6.85
Forfeited		(68,672	)		8.16
Unvested at December 31, 2023		6,053,823			8.00

Schedule of Share-based Compensation, Restricted Stock Units, Activity

RSUs outstanding under the 2009 Plan as of December 31, 2023, and changes during each of the years in the three-year period prior to December 31, 2023, were as follows:


	Shares			Weighted- Average Grant Date Fair Value
Unvested at December 31, 2020		613,739		$	4.89
Granted		173,664			8.81
Vested		(300,805	)		5.09
Forfeited		—			—
Unvested at December 31, 2021		486,598			6.17
Granted		176,820			9.66
Vested		(151,058	)		5.63
Forfeited		—			—
Unvested at December 31, 2022		512,360			7.54
Granted		365,037			6.15
Vested		(101,471	)		7.75
Forfeited		—			—
Unvested at December 31, 2023		775,926			6.86

Long-Term Debt - 4.750% Senior Secured Notes, Due 2031 - Additional Information (Details) - Senior Secured Notes - USD ($) $ in Millions		12 Months Ended
	Feb. 09, 2021	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument Redemption Period Six
Debt Instrument [Line Items]
Debt instrument stated interest rate	4.75%
Debt instrument, maturity year	2031
Debt instrument redemption description	plus a “make-whole” premium, as described in the indenture governing the 4¾% Senior Secured Notes due 2031
Debt instrument optional redemption date	Feb. 15, 2026
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Debt instrument redemption price percentage	100.00%
Senior Secured Notes at 4.75%, Due 2031
Debt Instrument [Line Items]
Debt instrument, offering date	Feb. 09, 2021
Debt instrument aggregate principal amount	$ 1,095
Debt instrument stated interest rate	4.75%	4.75%	4.75%
Debt instrument, maturity date	Feb. 15, 2031
Debt instrument, maturity year	2031	2031	2031
Debt instrument redemption description		The 4¾% Senior Secured Notes due 2031 bear interest at a rate of 4.750% per year payable semi-annually in arrears on February 15 and August 15, commencing on August 15, 2021.
Debt instrument optional redemption date	Feb. 15, 2026
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Senior Secured Notes at 4.75%, Due 2031 \| Redeem up to 40% Principal Amount Prior to February 15, 2024
Debt Instrument [Line Items]
Debt instrument stated interest rate	4.75%
Debt instrument, maturity year	2031
Debt instrument optional redemption date	Feb. 15, 2024
Debt instrument redemption price percentage	104.75%
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%
Senior Secured Notes at 4.75%, Due 2031 \| Redeem up to 10% Principal Amount Prior to February 15, 2026
Debt Instrument [Line Items]
Debt instrument redemption description	plus accrued and unpaid interest, if any. In addition, any time prior to February 15, 2026, but not more than once during each 12 month period
Debt instrument redemption price percentage	103.00%
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	10.00%
Senior Secured Notes At8625 Due2024
Debt Instrument [Line Items]
Debt instrument stated interest rate	8.625%
Debt instrument, maturity year	2024
Debt instrument redemption date	Feb. 09, 2021

Comprehensive Loss

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Comprehensive Loss

14. COMPREHENSIVE LOSS


	Change in
	Fair Value of			Change in
	Available-for-Sale			Unrecognized
	Debt			Pension Cost
	Securities			Components			AOCL
Balance as of December 31, 2022	$	(19	)	$	(2	)	$	(21	)
Other comprehensive income
before reclassifications		6			1			7
Amounts reclassified from
AOCL		—			—			—
Net current-period other
comprehensive income		6			1			7
Balance as of December 31, 2023	$	(13	)	$	(1	)	$	(14	)


	Change in
	Fair Value of			Change in
	Available-for-Sale			Unrecognized
	Debt			Pension Cost
	Securities			Components			AOCL
Balance as of December 31, 2021	$	(2	)	$	(12	)	$	(14	)
Other comprehensive (loss)
income before reclassifications		(16	)		10			(6	)
Amounts reclassified from
AOCL		(1	)		—			(1	)
Net current-period other
comprehensive (loss) income		(17	)		10			(7	)
Balance as of December 31, 2022	$	(19	)	$	(2	)	$	(21	)

There were no significant reclassifications to net (loss) income out of AOCL for the years ended December 31, 2023 and 2022.

Long-Term Debt - Summary of Extinguished Portion of Certain Series of Outstanding Notes (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished	$ 402	$ 645
Senior Notes \| 6.875% Senior Notes due 2028
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished		11
Senior Secured Notes \| 6% Senior Secured Notes due 2029
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished	256
Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished		37
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished	142	389
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Extinguishment Of Debt [Line Items]
Total principal amount of debt extinguished	$ 4	$ 208

Acquisitions, Divestitures and Closures - Schedule of Divestitures (Details) - Item	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Greenbrier Valley Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	122
Effective Date	Jan. 01, 2023
Plateau Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	25
Effective Date	Apr. 01, 2023
Medical Center of South Arkansas
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	166
Effective Date	Jul. 01, 2023
Lutheran Rehabilitation Hospital
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	36
Effective Date	Sep. 01, 2023
AllianceHealth Ponca City
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	140
Effective Date	Nov. 01, 2023
AllianceHealth Woodward
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	87
Effective Date	Nov. 01, 2023
Bravera Health Brooksville
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	120
Effective Date	Dec. 01, 2023
Bravera Health Spring Hill
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	124
Effective Date	Dec. 01, 2023
Bravera Health Seven Rivers
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	128
Effective Date	Dec. 01, 2023
AllianceHealth Seminole
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds		32
Effective Date		Jul. 01, 2022
Lea Regional Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			84
Effective Date			Jan. 01, 2021
Tennova Healthcare - Tullahoma
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			135
Effective Date			Jan. 01, 2021
Tennova Healthcare - Shelbyville
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			60
Effective Date			Jan. 01, 2021
Northwest Mississippi Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			181
Effective Date			Feb. 01, 2021
Alliance Health Midwest
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			255
Effective Date			Apr. 01, 2021

Basis of Presentation and Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2023 USD ($) Hospital Item	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Business Description [Abstract]
Number of affiliated hospitals owned and leased by subsidiaries \| Hospital	71
Number of beds \| Item	12,000
Number of sites of care operates \| Item	1,000
Cost of Revenue, Policy [Abstract]
Corporate Office Costs	$ 248,000,000	$ 229,000,000	$ 222,000,000
Stock-based compensation expense	22,000,000	20,000,000	25,000,000
Marketable Securities, Policy [Abstract]
Net change in fair value of available-for-sale debt securities, net of tax	6,000,000	(17,000,000)	(5,000,000)
Property and Equipment, Policy [Abstract]
Construction in Progress, Gross	343,000,000	234,000,000
Interest Costs Capitalized	13,000,000	9,000,000	13,000,000
Purchases of property and equipment and internal-use software accrued in accounts payable	101,000,000	87,000,000
Goodwill, Policy [Abstract]
Impairment of goodwill	0	0	0
Third Party Reimbursement [Abstract]
Amounts due to third party payors	97,000,000	101,000,000
Amounts due from third party payors	130,000,000	97,000,000
Net Operating Revenues, Policy [Abstract]
Charity care services charges excluded from net operating revenues	1,300,000,000	1,400,000,000	1,100,000,000
Value of charity care services at the Company's standard charges included in contractual allowances	140,000,000	166,000,000	123,000,000
Concentration of Credit Risk, Policy [Abstract]
Accounts receivable, net of contractual allowances	2,231,000,000	2,040,000,000
Accounting for the Impairment or Disposal of Long-Lived Assets
Impairment of long-lived assets sold		71,000,000
Amount related to closure of hospitals		44,000,000
Amount related to expiration or planned non-renewal of leases		9,000,000
Amount related to several assets idled disposed or held for sale		11,000,000
C A R E S Act And P P P H C E Act Funds [Abstract]
Pandemic Relief Funds		$ 173,000,000	148,000,000
New Accounting Pronouncements, Policy [Abstract]
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]		true
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]		true
Public Health and Social Services Emergency Fund (the "PHSSEF") \| CARES Act \| Paycheck Protection Program, Health Care Enhancement Act And the American Rescue Plan Act of 2021
C A R E S Act And P P P H C E Act Funds [Abstract]
Accelerated Payments Received Returned Under Cares Act		$ 161,000,000	58,000,000
Public Health and Social Services Emergency Fund (the "PHSSEF") \| CARES Act \| Paycheck Protection Program And Health Care Enhancement Act \| Operating Costs and Expenses
C A R E S Act And P P P H C E Act Funds [Abstract]
Accelerated Payments Received Returned Under Cares Act		173,000,000	$ 148,000,000
Adjustment for Carrying Value of Other Long-Lived Assets at Underperforming Hospitals
Accounting for the Impairment or Disposal of Long-Lived Assets
Impairment of long-lived assets held for sale		7,000,000
Hospitals Sold Or Deemed Held For Sale
Accounting for the Impairment or Disposal of Long-Lived Assets
Gain (loss) on disposition of business	(87,000,000)
Gain Loss On Sales Of Assets And Asset Impairment Charges Gross	145,000,000
Impairment of amount related to several assets idled disposed or held for sale	9,000,000
Adjustment for Carrying Value of Other Long-Lived Assets at Underperforming Hospitals
Accounting for the Impairment or Disposal of Long-Lived Assets
Impairment of long-lived assets held for sale	49,000,000
Shared Service Center
Accounting for the Impairment or Disposal of Long-Lived Assets
Gain (loss) on disposition of business	186,000,000
Medicare
Concentration of Credit Risk, Policy [Abstract]
Accounts receivable, net of contractual allowances	$ 194,000,000	$ 198,000,000
Accounts receivable net of contractual allowances, percent	6.00%	6.00%
Physician Recruitment Contracts
Other Assets, Policy [Abstract]
Term of Physician Recruitment Contract	3 years
Physician Income Guarantees, Policy [Abstract]
Physicians recruitment agreement period	1 year
Term of Physician Recruitment Contract	3 years
Unamortized portion of physician income guarantees	$ 9,000,000	$ 12,000,000
Capitalized Internal Use Software, Significant System Conversions
Other Assets, Policy [Abstract]
Finite-Lived Intangible Assets, Weighted-Average Useful Life	3 years
Capitalized Internal Use Software Except Significant System Conversions
Other Assets, Policy [Abstract]
Finite-Lived Intangible Assets, Weighted-Average Useful Life	3 years
Land Improvements \| Minimum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	3 years
Land Improvements \| Maximum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	20 years
Building and Building Improvements \| Minimum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	5 years
Building and Building Improvements \| Maximum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	40 years
Equipment and Fixtures \| Minimum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	3 years
Equipment and Fixtures \| Maximum
Property and Equipment, Policy [Abstract]
Property, Plant and Equipment, Useful Life	18 years
Certain Facility
Property and Equipment, Policy [Abstract]
Non-cash investing activity through capital leases	$ 1,000,000
Geographic Concentration Risk \| Indiana \| Sales Revenue, Net
Business Description [Abstract]
Concentration Risk, Percentage	17.10%	17.30%	16.40%
Geographic Concentration Risk \| Florida \| Sales Revenue, Net
Business Description [Abstract]
Concentration Risk, Percentage	11.10%	11.60%	12.20%
Geographic Concentration Risk \| Texas \| Sales Revenue, Net
Business Description [Abstract]
Concentration Risk, Percentage	11.70%	11.70%	11.00%
Geographic Concentration Risk \| Alabama \| Sales Revenue, Net
Business Description [Abstract]
Concentration Risk, Percentage	14.40%	13.30%	13.00%

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Components of Lease Cost and Rent Expense

The components of lease cost and rent expense for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):


	Year Ended December 31,
Lease Cost	2023			2022			2021
Operating lease cost:
Operating lease cost	$	211		$	211		$	196
Short-term rent expense		90			87			92
Variable lease cost		23			24			25
Sublease income		(5	)		(5	)		(5	)
Total operating lease cost	$	319		$	317		$	308
Finance lease cost:
Amortization of ROU assets	$	13		$	13		$	9
Interest on finance lease liabilities		13			15			9
Total finance lease cost	$	26		$	28		$	18

Supplemental Balance Sheet Information Related to Leases

Supplemental balance sheet information related to leases was as follows (in millions):


	Balance Sheet Classification	December 31, 2023			December 31, 2022
Operating Leases:
Operating Lease ROU Assets	Other assets, net	$	665		$	738

Finance Leases:
Finance Lease ROU Assets	Property and equipment
	Land and improvements	$	—		$	—
	Buildings and improvements		246			261
	Equipment and fixtures		10			12
	Property and equipment		256			273
	Less accumulated depreciation and amortization		(55	)		(56	)
	Property and equipment, net	$	201		$	217

Current finance lease liabilities	Current maturities of long-term debt	$	2		$	3
Long-term finance lease liabilities	Long-term debt		214			220

Supplemental Cash Flow and Other Information Related to Leases

Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):


	Year Ended December 31,
Cash flow information	2023			2022			2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases (1)	$	200		$	204		$	197
Operating cash flows from finance leases		13			15			9
Financing cash flows from finance leases		3			9			4
ROU assets obtained in exchange for new finance lease liabilities		1			42			166
ROU assets obtained in exchange for new operating lease liabilities		102			195			143
Weighted-average remaining lease term:
Operating leases	9 years			8 years			6 years
Finance leases	30 years			31 years			30 years
Weighted-average discount rate:
Operating leases		8.8	%		8.0	%		8.1	%
Finance leases		6.2	%		6.4	%		6.3	%

(1)

Included in the change in other operating assets and liabilities in the consolidated statements of cash flows.

Commitments Relating To Noncancellable Operating And Finance Leases And Financing Obligations

Commitments relating to noncancellable operating and finance leases and financing obligations for each of the next five years and thereafter are as follows (in millions):


							Financing
Year Ending December 31,	Operating			Finance			Obligations
2024	$	181		$	16		$	13
2025		144			15			13
2026		118			16			13
2027		92			16			13
2028		75			16			14
Thereafter		467			472			59
Total minimum future payments		1,077			551			125
Less: Imputed interest		(390	)		(335	)		26
Total liabilities		687			216			151
Less: Current portion		(124	)		(2	)		(3	)
Long-term liabilities	$	563		$	214		$	148

Fair Value - Supplemental Information Regarding Available-for-Sale Debt Securities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Schedule Of Available For Sale Securities [Line Items]
Amortized Cost	$ 199	$ 201
Gross Unrealized Losses	(17)	(22)
Estimated Fair Value	182	179
Government
Schedule Of Available For Sale Securities [Line Items]
Amortized Cost	118	107
Gross Unrealized Losses	(10)	(11)
Estimated Fair Value	108	96
Corporate
Schedule Of Available For Sale Securities [Line Items]
Amortized Cost	65	69
Gross Unrealized Losses	(6)	(9)
Estimated Fair Value	59	60
Mortgage and Asset-Backed Securities
Schedule Of Available For Sale Securities [Line Items]
Amortized Cost	16	25
Gross Unrealized Losses	(1)	(2)
Estimated Fair Value	$ 15	$ 23

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aaa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

+ Details

Acquisitions, Divestitures and Closures - Acquisitions - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Physician Practices, Clinics, Ambulatory Surgery Centers and Other Ancillary Businesses
Acquisitions and Divestitures [Line Items]
Business acquisition, cost of acquired entity, purchase price	$ 38	$ 9	$ 3
American Physician Partners
Acquisitions and Divestitures [Line Items]
Business acquisition, cost of acquired entity, purchase price	$ 20

Commitments and Contingencies

12 Months Ended

Dec. 31, 2023

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

15. COMMITMENTS AND CONTINGENCIES

Construction and Other Capital Commitments. Pursuant to a hospital purchase agreement from the Company’s March 1, 2016 acquisition of Northwest Health – Starke, formerly known as Starke Hospital, the Company is committed to spend up to $15 million toward the construction of a replacement facility in Knox, Indiana. Under the terms of such agreement, the construction of the replacement facility for Northwest Health - Starke is required to be completed within five years of the date the Company entered into a new lease with Starke County, Indiana, the hospital lessor, or in the event the Company does not enter into a new lease with Starke County, construction shall be completed by September 30, 2026. The Company has not entered into a new lease with the lessor for Northwest Health - Starke.

Physician Recruiting Commitments. As part of its physician recruitment strategy, the Company provides income guarantee agreements to certain physicians who agree to relocate to its communities and commit to remain in practice there. Under such agreements, the Company is required to make payments to the physicians in excess of the amounts they earned in their practice up to the amount of the income guarantee. These income guarantee periods are typically for 12 months. Such payments are recoverable by the Company from physicians who do not fulfill their commitment period, which is typically three years, to the respective community. At December 31, 2023, the maximum potential amount of future payments under these guarantees in excess of the liability recorded is $6 million.

Professional Liability Claims. As part of the Company's business of providing healthcare services, it is subject to legal actions alleging liability on its part. The Company accrues for losses resulting from such liability claims, as well as loss adjustment expenses that are out-of-pocket and directly related to such liability claims. These direct out-of-pocket expenses include fees of outside counsel and experts. The Company does not accrue for costs that are part of corporate overhead, such as the costs of in-house legal and risk management departments. The losses resulting from professional liability claims primarily consist of estimates for known claims, as well as estimates for incurred but not reported claims. The estimates are based on specific claim facts, historical claim reporting and payment patterns, the nature and level of hospital operations, and actuarially determined projections. The actuarially determined projections are based on the Company's actual claim data, including historic reporting and payment patterns, which have been gathered over the life of the Company. As discussed below, since the Company purchases excess insurance on a claims-made basis that transfers risk to third-party insurers, the estimated liability for professional and general liability claims does include an amount for the losses covered by excess insurance. The Company also records a receivable for the expected reimbursement of losses covered by this excess insurance. Since the Company believes that the amount and timing of its future claims payments are reliably determinable, it discounts the amount that is accrued for losses resulting from professional liability claims.

The net present value of the projected payments was discounted using weighted-average interest rates of 3.7% in 2023, 3.8% in 2022 and 1.8% in 2021. This liability is adjusted for new claims information in the period such information becomes known. The Company’s estimated liability for professional and general liability claims was $443 million and $467 million as of December 31, 2023 and 2022, respectively. The estimated undiscounted claims liability was $498 million and $516 million as of December 31, 2023 and 2022, respectively. The current portion of the liability for professional and general liability claims was $119 million and $159 million as of December 31, 2023 and 2022, respectively, and is included in other accrued liabilities in the accompanying consolidated balance sheets, with the long-term portion recorded in other long-term liabilities. Professional liability expense includes the losses resulting from professional liability claims and loss adjustment expense, as well as excess insurance premiums, and is presented within other operating expenses in the accompanying consolidated statements of (loss) income.

The Company’s processes for obtaining and analyzing claims and incident data are standardized across all of its businesses and have been consistent for many years. The Company monitors the outcomes of the medical care services that it provides and for each reported claim, the Company obtains various information concerning the facts and circumstances related to that claim. In addition, the Company routinely monitors current key statistics and volume indicators in its assessment of utilizing historical trends. The average lag period between claim occurrence and payment of a final settlement is between three and four years, although the facts and circumstances of individual claims could result in the timing of such payments being different from this average. Since claims are paid promptly after settlement with the claimant is reached, settled claims represent approximately 1% or less of the total liability at the end of any period.

For purposes of estimating its individual claim accruals, the Company utilizes specific claim information, including the nature of the claim, the expected claim amount, the year in which the claim occurred and the laws of the jurisdiction in which the claim occurred. Once the case accruals for known claims are determined, information is stratified by loss layers and retentions, accident years, reported years and geography. Several actuarial methods are used against this data to produce estimates of ultimate paid losses and reserves for incurred but not reported claims. Each of these methods uses company-specific historical claims data and other information. This company-specific data includes information regarding the Company’s business, including historical paid losses and loss adjustment expenses, historical and current case loss reserves, actual and projected hospital statistical data, a variety of hospital census information, employed physician information, professional liability retentions for each policy year, geographic information and other data.

Based on these analyses, the Company determines its estimate of the professional liability claims. The determination of management’s estimate, including the preparation of the reserve analysis that supports such estimate, involves subjective judgment of management. Changes in reserve data or the trends and factors that influence reserve data may signal fundamental shifts in the Company’s future claim development patterns or may simply reflect single-period anomalies. Even if a change reflects a fundamental shift, the full extent of the change may not become evident until years later. Moreover, since the Company’s methods and models use different types of data and the Company selects its liability from the results of all of these methods, it typically cannot quantify the precise impact of such factors on its estimates of the liability. Due to the Company’s standardized and consistent processes for handling claims and the long history and depth of company-specific data, the Company’s methodologies have produced reliably determinable estimates of ultimate paid losses. Management considers any changes in the amount and pattern of its historical paid losses up through the most recent reporting period to identify any fundamental shifts or trends in claim development experience in determining the estimate of professional liability claims. However, due to the subjective nature of this estimate and the impact that previously unforeseen shifts in actual claim experience can have, future estimates of professional liability could be adversely impacted when actual paid losses develop unexpectedly based on assumptions and settlement events that were not previously known or anticipated.

During the year ended December 31, 2020, the Company incurred expenses in the amount of approximately $50 million related to the settlement of a professional liability claim for which the Company’s third-party insurers’ obligation to provide coverage to the Company in connection with the underlying loss was being litigated. In the ordinary course of business, the Company’s expense with respect to professional liability claims, which is actuarially determined, is limited to amounts not covered by third-party insurance policies, which typically provide coverage for professional liability claims. The subject of the litigation for the recovery of the full amount of the $50 million settlement was whether the claim was covered under the subject policies. This litigation was settled during the three months ended December 31, 2021, and in connection with this settlement, approximately $22 million was recovered from various third-party insurers related to their obligation to provide coverage for the professional liability claim. During the year ended December 31, 2022, the Company experienced an increase in the amounts paid or expected to be paid to settle outstanding professional liability claims related to divested locations, compared to the same period in the prior year and to previous actuarially determined estimates. This resulted in a change in estimate of $15 million during the three months and year ended December 31, 2022. During the year ended December 31, 2023, the Company experienced an increase in the amounts paid or expected to be paid to settle outstanding professional liability claims, compared to the same period in the prior year and to previous actuarially determined estimates due to adverse claim developments. There were no other significant changes in the Company’s estimate of the reserve for professional liability claims during the years ended December 31, 2023, 2022 and 2021.

The Company is primarily self-insured for professional liability claims; however, the Company obtains excess insurance that transfers the risk of loss to a third-party insurer for claims in excess of the Company’s self-insured retentions. The Company’s excess insurance is underwritten on a claims-made basis. For claims reported prior to June 1, 2002, substantially all of the Company’s professional and general liability risks were subject to a less than $1 million per occurrence self-insured retention and for claims reported from June 1, 2002 through June 1, 2003, these self-insured retentions were $2 million per occurrence. Substantially all claims reported after June 1, 2003 and before June 1, 2005 are self-insured up to $4 million per claim. Substantially all claims reported on or after June 1, 2005 and before June 1, 2014 are self-insured up to $5 million per claim. Substantially all claims reported on or after June 1, 2014 and before June 1, 2018 are self-insured up to $10 million per claim. Substantially all claims reported on or after June 1, 2018 are self-insured up to $15 million per claim. Management, on occasion, has selectively increased the insured risk at certain hospitals based upon insurance pricing and other factors and may continue that practice in the future.

Excess insurance for all hospitals has been purchased through commercial insurance companies and generally covers the Company for liabilities in excess of the self-insured retentions. The excess coverage consists of multiple layers of insurance, the sum of which totals up to $95 million per occurrence and in the aggregate for claims reported on or after June 1, 2003, up to $145 million per occurrence and in the aggregate for claims reported on or after January 1, 2008, up to $195 million per occurrence and in the aggregate for claims reported on or after June 1, 2010, and up to at least $215 million per occurrence and in the aggregate for claims reported on or after June 1, 2015. In addition, for integrated professional liability claims, there is an additional $50 million of excess coverage for claims reported on or after June 1, 2014 and an additional $75 million of excess coverage for claims reported on or after June 1, 2015 through June 1, 2020. The $75 million in integrated occurrence coverage will also apply to claims reported between June 1, 2020 and June 1, 2024 for events that occurred prior to June 1, 2020 but which were not previously known or reported. For certain policy years prior to June 1, 2014, if the first aggregate layer of excess coverage becomes fully utilized, then the self-insured retention will increase to $10 million per claim for any subsequent claims in that policy year until the Company’s total aggregate coverage is met. Beginning June 1, 2018, this drop-down provision in the excess policies attaches over the $15 million per claim self-insured retention.

Summary of Recorded Amounts


	Probable
	Contingencies
Balance as of December 31, 2021	$	20
Expense		8
Reserve for insured claim		—
Cash payments		(17	)
Balance as of December 31, 2022		11
Expense		38
Reserve for insured claim		5
Cash payments		(47	)
Balance as of December 31, 2023	$	7

In accordance with applicable accounting guidance, the Company establishes a liability for litigation, regulatory and governmental matters for which, based on information currently available, the Company believes that a negative outcome is known or is probable and the amount of the loss is reasonably estimable. For all such matters (whether or not discussed in this contingencies footnote), such amounts have been recorded in other accrued liabilities in the consolidated balance sheets and are included in the table above. Due to the uncertainties and difficulty in predicting the ultimate resolution of these contingencies, the actual amount could differ from the estimated amount reflected as a liability in the consolidated balance sheets.

Long-Term Debt - Schedule of Early Redemption Prices on 4.750% Senior Notes Due 2031 (Details) - Senior Secured Notes - Senior Secured Notes at 4.75%, Due 2031	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	102.375%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2026
Debt Instrument, Redemption Period, End Date	Feb. 14, 2027
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	101.583%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2027
Debt Instrument, Redemption Period, End Date	Feb. 14, 2028
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.792%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2028
Debt Instrument, Redemption Period, End Date	Feb. 14, 2029
Debt Instrument, Redemption, Period Four
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2029
Debt Instrument, Redemption Period, End Date	Feb. 14, 2031

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Restricted Stock, Activity (Details) - Restricted Stock - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Unvested Shares	5,541,065	4,995,314	4,555,735
Granted, Shares	2,746,000	3,253,000	2,929,250
Vested, Shares	(2,164,570)	(2,561,575)	(2,312,328)
Forfeited, Shares	(68,672)	(145,674)	(177,343)
Ending Balance, Unvested Shares	6,053,823	5,541,065	4,995,314
Beginning of Period, Weighted Average Grant Date Fair Value	$ 8.53	$ 6.30	$ 4.84
Granted, Weighted Average Grant Date Fair Value	6.04	8.95	8.16
Vested, Weighted Average Grant Date Fair Value	6.85	5.70	4.68
Forfeited, Weighted Average Grant Date Fair Value	8.16	8.89	6.33
End of Period, Weighted Average Grant Date Fair Value	$ 8	$ 8.53	$ 6.30

Long-Term Debt - Schedule of Early Redemption Prices on 5.250% Senior Notes Due 2030 (Details) - Senior Secured Notes at 5.25%, Due 2030 - Senior Secured Notes		12 Months Ended
	Feb. 04, 2022	Dec. 31, 2023
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	105.25%	102.625%
Debt Instrument, Redemption Period, Start Date		May 15, 2025
Debt Instrument, Redemption Period, End Date		May 14, 2026
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	103.00%	101.313%
Debt Instrument, Redemption Period, Start Date		May 15, 2026
Debt Instrument, Redemption Period, End Date		May 14, 2027
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage		100.00%
Debt Instrument, Redemption Period, Start Date		May 15, 2027
Debt Instrument, Redemption Period, End Date		May 14, 2030

Earnings Per Share - Additional Information (Details)	12 Months Ended
Earnings Per Share - Additional Information (Details)	Dec. 31, 2023 shares
Earnings Per Share [Abstract]
Increase in number of shares to diluted shares calculation if income would have been generated	422,487

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Operating Leases:
Operating Lease, Right-of-Use Asset	$ 665	$ 738
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other assets, net of accumulated amortization of $1,518 and $1,392 at December 31, 2023 and 2022, respectively	Other assets, net of accumulated amortization of $1,518 and $1,392 at December 31, 2023 and 2022, respectively
Finance Leases:
Property and equipment	$ 9,511	$ 9,639
Less accumulated depreciation and amortization	(4,304)	(4,274)
Property and equipment, net	5,207	5,365
Current finance lease liabilities	$ 2	$ 3
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Current maturities of long-term debt	Current maturities of long-term debt
Long-term finance lease liabilities	$ 214	$ 220
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Long-term debt	Long-term debt
Finance Lease ROU Assets
Finance Leases:
Property and equipment	$ 256	$ 273
Less accumulated depreciation and amortization	(55)	(56)
Property and equipment, net	201	217
Finance Lease ROU Assets \| Building and Improvements
Finance Leases:
Property and equipment	246	261
Finance Lease ROU Assets \| Equipment and Fixtures
Finance Leases:
Property and equipment	$ 10	$ 12

Basis of Presentation and Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Net Operating Revenues


	Year Ended December 31,
	2023		2022		2021
Medicare	$	2,484	$	2,547	$	2,650
Medicare Managed Care		2,103		1,968		1,861
Medicaid		1,790		1,807		1,671
Managed Care and other third-party payors		5,978		5,806		6,076
Self-pay		135		83		110
Total	$	12,490	$	12,211	$	12,368

Income Taxes - Schedule of Components of Deferred Income Taxes (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Assets
Net operating loss and credit carryforwards	$ 533	$ 553
Self-insurance liabilities	16	30
Long-term debt and interest	32	41
Accounts receivable	16	16
IRC Section 163(j) interest limitation	582	448
Accrued vacation	19	19
Accrued bonus	27	19
Other comprehensive income	4	6
Right-of-use liability	173	156
Stock-based compensation	4	5
Deferred compensation	38	51
Deferred Tax Liability Section481 Adjustments	57	122
Other	19	19
Total	1,463	1,363
Valuation allowance	(983)	(829)
Total Deferred Income Tax Assets, Net	480	534
Liabilities
Property and equipment	326	323
Prepaid expenses	30	31
Intangibles	163	148
Investments in unconsolidated affiliates	72	58
Other liabilities	7	9
Right-of-use assets	165	148
IRC Section 481(a) adjustments	57	122
Total	820	839
Total Deferred Income Tax Liabilities, Gross	$ 820	$ 839

Long-Term Debt - 6.125% Junior-Priority Secured Notes, Due 2030 - Additional Information (Details) - Junior-Priority Secured Notes - Junior-Priority Secured Notes at 6.125% Due 2030 - USD ($) $ in Millions		12 Months Ended
	May 19, 2021	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt instrument, offering date	May 19, 2021
Debt instrument aggregate principal amount	$ 1,440
Debt instrument stated interest rate	6.125%	6.125%	6.125%
Debt instrument, maturity date	Apr. 01, 2030
Debt instrument, maturity year	2030	2030	2030
Debt instrument, frequency of periodic payment		The 6⅛% Junior-Priority Secured Notes due 2030 bear interest at a rate of 6.125% per year payable semi-annually in arrears on April 1 and October 1, commencing on October 1, 2021
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Debt instrument redemption price percentage	100.00%
Debt instrument optional redemption date	Apr. 01, 2025
Debt instrument redemption description		plus a “make-whole” premium, as described in the indenture governing the 6⅛% Junior-Priority Secured Notes due 2030.
Redeem up to 40% Principal Amount Prior to May 15, 2024
Debt Instrument [Line Items]
Debt instrument redemption price percentage	106.125%
Debt instrument optional redemption date	May 15, 2024
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%

Long-Term Debt - 6.875% Senior Secured Notes, Due 2029 - Additional Information (Details) - Junior-Priority Secured Notes - USD ($) $ in Millions		12 Months Ended
	Feb. 02, 2021	Dec. 31, 2023	Dec. 31, 2022
Junior-Priority Secured Notes at 6.875% Due 2029
Debt Instrument [Line Items]
Debt instrument, offering date	Feb. 02, 2021
Debt instrument aggregate principal amount	$ 1,775
Debt instrument stated interest rate	6.875%	6.875%	6.875%
Debt instrument, maturity date	Apr. 15, 2029
Debt instrument, maturity year	2029	2029	2029
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Debt instrument redemption price percentage	100.00%
Debt instrument optional redemption date	Apr. 15, 2024
Debt instrument redemption description	plus a “make-whole” premium, as described in the indenture governing the 6⅞% Junior-Priority Secured Notes due 2029
Junior-Priority Secured Notes at 6.875% Due 2029 \| Debt Instrument, Redemption, Period Five
Debt Instrument [Line Items]
Debt instrument redemption price percentage	106.875%
Debt instrument optional redemption date	Apr. 15, 2024
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%
Junior-Priority Secured Notes at 9.875% Due 2023
Debt Instrument [Line Items]
Debt instrument stated interest rate	9.875%
Debt instrument, maturity year	2023

Long-Term Debt - Summary of Extinguished Portion of Certain Series of Outstanding Notes (Parenthetical) (Details)				12 Months Ended
	May 19, 2021	Feb. 09, 2021	Feb. 02, 2021	Dec. 31, 2023	Dec. 31, 2022
Senior Notes \| 6.875% Senior Notes due 2028
Extinguishment Of Debt [Line Items]
Debt instrument, interest rate, stated percentage				6.875%	6.875%
Debt instrument, maturity year				2028
Senior Secured Notes \| 6% Senior Secured Notes due 2029
Extinguishment Of Debt [Line Items]
Debt instrument, interest rate, stated percentage				6.00%
Debt instrument, maturity year				2029
Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Extinguishment Of Debt [Line Items]
Debt instrument, interest rate, stated percentage		4.75%		4.75%	4.75%
Debt instrument, maturity year		2031		2031	2031
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Extinguishment Of Debt [Line Items]
Debt instrument, interest rate, stated percentage			6.875%	6.875%	6.875%
Debt instrument, maturity year			2029	2029	2029
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Extinguishment Of Debt [Line Items]
Debt instrument, interest rate, stated percentage	6.125%			6.125%	6.125%
Debt instrument, maturity year	2030			2030	2030

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Taxes

The provision for income taxes consists of the following (in millions):


	Year Ended December 31,
	2023			2022			2021
Current:
Federal	$	149		$	—		$	(46	)
State		7			5			6
		156			5			(40	)
Deferred:
Federal		(5	)		166			161
State		40			(1	)		10
		35			165			171
Total provision for income taxes for income	$	191		$	170		$	131

Schedule of Reconciliation between the Statutory Federal Income Tax Rate and the Effective Tax Rate

The following table reconciles the differences between the statutory federal income tax rate and the effective tax rate (dollars in millions):


	Year Ended December 31,
	2023						2022						2021
	Amount			%			Amount			%			Amount			%
Provision for income taxes at statutory federal rate	$	44			21.0	%	$	73			21.0	%	$	105			21.0	%
State income taxes, net of federal income tax benefit		37			17.9			3			0.8			44			8.7
Net income attributable to noncontrolling interests		(31	)		(14.9	)		(28	)		(8.0	)		(29	)		(5.8	)
Change in valuation allowance		88			42.5			122			34.9			33			6.8
Change in uncertain tax position		10			4.9			—			—			—			—
Nondeductible goodwill		29			14.1			—			—			—			—
Amended return adjustments		9			4.3			—			—			(22	)		(4.4	)
Other		5			2.5			—			—			—			—
Provision for income taxes and effective tax rate for income	$	191			92.3	%	$	170			48.7	%	$	131			26.3	%

Schedule of Components of Deferred Income Taxes


	December 31,
	2023					2022
	Assets			Liabilities		Assets			Liabilities
Net operating loss and credit carryforwards	$	533		$	—	$	553		$	—
Property and equipment		—			326		—			323
Self-insurance liabilities		16			—		30			—
Prepaid expenses		—			30		—			31
Intangibles		—			163		—			148
Investments in unconsolidated affiliates		—			72		—			58
Other liabilities		—			7		—			9
Long-term debt and interest		32			—		41			—
Accounts receivable		16			—		16			—
IRC Section 163(j) interest limitation		582			—		448			—
Accrued vacation		19			—		19			—
Accrued bonus		27			—		19			—
Other comprehensive income		4			—		6			—
Right-of-use assets		—			165		—			148
Right-of-use liability		173			—		156			—
Stock-based compensation		4			—		5			—
Deferred compensation		38			—		51			—
IRC Section 481(a) adjustments		—			57		—			122
Other		19			—		19			—
Total		1,463			820		1,363			839
Valuation allowance		(983	)		—		(829	)		—
Total deferred income taxes	$	480		$	820	$	534		$	839

Schedule of Reconciliation of the Total Amount of Unrecognized Tax Benefit

The following is a tabular reconciliation of the total amount of unrecognized tax benefit for the years ended December 31, 2023, 2022 and 2021 (in millions):


	Year Ended December 31,
	2023			2022		2021
Unrecognized tax benefit, beginning of year	$	50		$	42	$	45
Gross increases — tax positions in current period		9			8		5
Reductions — tax positions in prior period		(1	)		—		(8	)
Unrecognized tax benefit, end of year	$	58		$	50	$	42

Condensed Financial Information of Parent Company

12 Months Ended

Dec. 31, 2023

Condensed Financial Information Disclosure [Abstract]

Condensed Financial Information of Parent Company

16. CONDENSED FINANCIAL INFORMATION OF PARENT COMPANY


Parent Company Only
Condensed Balance Sheets
(In millions)
	December 31,
	2023			2022
ASSETS
Prepaid income taxes	$	77		$	99
Total current assets		77			99
Deferred income taxes		29			49
Other assets, net		—			—
Total assets	$	106		$	148
LIABILITIES AND STOCKHOLDERS' DEFICIT
Intercompany payable	$	1,083		$	1,159
Deferred income taxes		369			354
Other long-term liabilities		46			2
Total liabilities		1,498			1,515
Community Health Systems, Inc. stockholders’ deficit:
Preferred stock		—			—
Common stock		1			1
Additional paid-in capital		2,185			2,084
Accumulated other comprehensive loss		(14	)		(21	)
Accumulated deficit		(3,564	)		(3,431	)
Total Community Health Systems, Inc. stockholders’ deficit		(1,392	)		(1,367	)
Total liabilities and stockholders' deficit	$	106		$	148

See note to condensed financial statements of Parent Company.


Parent Company Only
Condensed Statements of (Loss) Income
(In millions)
	Year Ended December 31,
	2023			2022			2021
Net operating revenues	$	—		$	—		$	—
Operating costs and expenses:
Salaries and benefits		—			—			—
Supplies		—			—			—
Other operating expenses		—			—			—
Lease cost and rent		—			—			—
Pandemic relief funds		—			—			—
Depreciation and amortization		—			—			—
Impairment and (gain) loss on sale of businesses, net		—			—			—
Total operating costs and expenses		—			—			—
Income from operations		—			—			—
Interest expense, net		—			—			—
(Gain) loss from early extinguishment of debt		—			—			—
Equity in loss (earnings) of unconsolidated affiliates		133			(46	)		(230	)
(Loss) income before income taxes		(133	)		46			230
Provision for (benefit from) income taxes		—			—			—
Net (loss) income		(133	)		46			230
Less: Net income attributable to noncontrolling interests		—			—			—
Net (loss) income attributable to Community Health Systems, Inc. stockholders	$	(133	)	$	46		$	230

See note to condensed financial statements of Parent Company.


Parent Company Only
Condensed Statements of Comprehensive (Loss) Income
(In millions)
	Year Ended December 31,
	2023			2022			2021
				(In millions)
Net (loss) income	$	(133	)	$	46		$	230
Equity in other comprehensive (loss) income of affiliates, net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax		6			(17	)		(5	)
Amortization and recognition of unrecognized pension cost components, net of tax		1			10			3
Other comprehensive income (loss)		7			(7	)		(2	)
Comprehensive (loss) income		(126	)		39			228
Less: Comprehensive income attributable to noncontrolling interests		—			—			—
Comprehensive (loss) income attributable to Community Health Systems, Inc. stockholders	$	(126	)	$	39		$	228

See note to condensed financial statements of Parent Company.


Parent Company Only
Condensed Statements of Cash Flows
(In millions)
	Year Ended December 31,
	2023			2022			2021
Cash flows from operating activities:
Net cash used in operating activities	$	(85	)	$	(13	)	$	(11	)
Cash flows from investing activities:
Net cash provided by (used in) investing activities		—			—			—
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements		(4	)		(8	)		(5	)
Changes in intercompany balances with affiliates, net		89			21			16
Net cash provided by financing activities		85			13			11
Net change in cash and cash equivalents		—			—			—
Cash and cash equivalents at beginning of period		—			—			—
Cash and cash equivalents at end of period	$	—		$	—		$	—

See note to condensed financial statements of Parent Company.

Basis of Presentation

The Parent Company is a holding company and operates no business in its own name; all of the Company’s business operations are conducted through subsidiaries of the Parent Company. The Company’s outstanding indebtedness restricts the ability of subsidiaries to dividend or otherwise provide funds to the Parent Company. Accordingly, these financial statements have been presented on a “parent-only” basis. Under parent-only presentation, the Parent Company’s investments in its consolidated subsidiaries are presented under the equity method of accounting. These parent-only financial statements should be read in conjunction with consolidated financial statements of Community Health Systems, Inc.

Stockholders' Deficit

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

STOCKHOLDERS' DEFICIT

11. STOCKHOLDERS’ DEFICIT

Authorized capital shares of the Company include 400,000,000 shares of capital stock consisting of 300,000,000 shares of common stock and 100,000,000 shares of preferred stock. Each of the aforementioned classes of capital stock has a par value of $0.01 per share. Shares of preferred stock, none of which were outstanding as of December 31, 2023, may be issued in one or more series having such rights, preferences and other provisions as determined by the Board of Directors without approval by the holders of common stock.

The Company is a holding company, which operates through its subsidiaries. The ABL Facility and the indentures governing each series of the Company’s outstanding notes contain various covenants under which the assets of the subsidiaries of the Company are subject to certain restrictions relating to, among other matters, dividends and distributions, as referenced in the paragraph below.

The ABL Facility and the indentures governing each series of the Company’s outstanding notes restrict the Company’s subsidiaries from, among other matters, paying dividends and making distributions to the Company, which thereby limits the Company’s ability to pay dividends and/or repurchase stock. As of December 31, 2023, under the most restrictive test in these agreements (and subject to certain exceptions), the Company has approximately $300 million of capacity to pay permitted dividends and/or repurchase shares of stock or make other restricted payments.

The following schedule discloses the effects of changes in the Company’s ownership interest in its less-than-wholly-owned subsidiaries on Community Health Systems, Inc. stockholders’ deficit (in millions):


	Year Ended December 31,
	2023			2022			2021
Net (loss) income attributable to Community Health Systems,
Inc. stockholders	$	(133	)	$	46		$	230
Transfers to the noncontrolling interests:
Net increase (decrease) in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests		5			(6	)		17
Net transfers to the noncontrolling interests		5			(6	)		17
Change to Community Health Systems, Inc. stockholders’ deficit from net (loss) income attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$	(128	)	$	40		$	247

- Definition

The entire disclosure for equity.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (h)
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-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 505
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481004/946-505-50-6

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480237/815-40-50-6

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.3-04)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480008/505-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(e)(1))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//505/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 16
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-16

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

+ Details

Fair Value - Gross Realized Gains and Losses and Investment Income on Available-for-Sale Debt Securities (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Realized gains			$ 1
Realized losses	$ (2)	$ (2)	$ (1)

Long-Term Debt - 10.875% Senior Secured Notes Due 2032 Additional Information (Details) - USD ($)			12 Months Ended
	Dec. 22, 2023	Feb. 09, 2021	Dec. 31, 2023	Dec. 31, 2022	Nov. 19, 2019	Mar. 06, 2019
Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument aggregate principal amount					$ 500,000,000
Senior Secured Notes \| Debt Instrument Redemption Period Six
Debt Instrument [Line Items]
Debt instrument, maturity year		2031
Debt instrument redemption description		plus a “make-whole” premium, as described in the indenture governing the 4¾% Senior Secured Notes due 2031
Debt instrument stated interest rate		4.75%
Maximum period notice for redemption of debt		60 days
Debt instrument redemption price percentage		100.00%
Debt instrument optional redemption date		Feb. 15, 2026
Senior Secured Notes \| Debt instrument redemption period to february 15, 2027
Debt Instrument [Line Items]
Debt instrument, maturity year	2032
Debt instrument redemption description	plus a “make-whole” premium, as described in the indenture governing the 10⅞% Senior Secured Notes due 2032
Debt instrument stated interest rate	10.875%
Maximum period notice for redemption of debt	60 days
Debt instrument redemption price percentage	100.00%
Debt instrument optional redemption date	Feb. 15, 2027
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032
Debt Instrument [Line Items]
Debt instrument aggregate principal amount	$ 1,000,000,000
Debt instrument, maturity date	Jan. 15, 2032
Debt instrument, maturity year	2032		2032	2032
Debt instrument redemption description	The 10⅞% Senior Secured Notes due 2032 bear interest at a rate of 10.875% per year payable semi-annually in arrears on February 15 and August 15, commencing on August 15, 2024
Debt instrument stated interest rate	10.875%		10.875%	10.875%
Maximum period notice for redemption of debt	60 days
Debt instrument optional redemption date	Feb. 15, 2027
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032 \| Redeem up to 40% Principal Amount Prior to February 15, 2027
Debt Instrument [Line Items]
Debt instrument, maturity year	2032
Debt instrument stated interest rate	10.875%
Debt instrument redemption price percentage	110.875%
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%
Debt instrument optional redemption date	Feb. 15, 2027
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032 \| Redeem up to 10% Principal Amount Prior to February 15, 2027
Debt Instrument [Line Items]
Debt instrument, maturity year	2032
Debt instrument redemption description	plus accrued and unpaid interest, if any. In addition, any time prior to February 15, 2027, but not more than once during each 12 month period
Debt instrument stated interest rate	10.875%
Debt instrument redemption price percentage	103.00%
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	10.00%
Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032 \| Debt Instrument Redemption Period
Debt Instrument [Line Items]
Debt instrument redemption description			plus accrued and unpaid interest, if any, on the 10⅞% Senior Secured Notes due 2032 redeemed, to, but excluding, the applicable date of redemption, if redeemed during the 12 month period beginning on February 15 of the years indicated below:
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument, offering date			Mar. 06, 2019
Debt instrument aggregate principal amount	$ 985,000,000				$ 2,101,000,000	$ 1,601,000,000
Debt instrument, maturity year			2026	2026
Debt instrument stated interest rate			8.00%	8.00%		8.00%

Fair Value of Financial Instruments - Schedule of Estimated Fair Value of Financial Instruments, by Balance Sheet Grouping (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Assets:
Available-for-sale debt securities	$ 182	$ 179
Carrying Amount
Assets:
Cash and cash equivalents	38	118
Investments in equity securities	69	107
Available-for-sale debt securities	182	179
Trading securities	5	5
Carrying Amount \| Senior Notes \| Senior Notes at 6.875% Due 2028
Liabilities:
Notes payable, fair value disclosure	750	749
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Liabilities:
Notes payable, fair value disclosure	1,109	2,083
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 8% Due 2027
Liabilities:
Notes payable, fair value disclosure	695	693
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Liabilities:
Notes payable, fair value disclosure	1,847	1,833
Carrying Amount \| Senior Secured Notes \| Senior Notes at 6% Due 2029
Liabilities:
Notes payable, fair value disclosure	622	865
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Liabilities:
Notes payable, fair value disclosure	1,458	1,448
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Liabilities:
Notes payable, fair value disclosure	1,054	1,053
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 10.875% Due 2032
Liabilities:
Notes payable, fair value disclosure	982
Carrying Amount \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Liabilities:
Notes payable, fair value disclosure	1,162	1,282
Carrying Amount \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Liabilities:
Notes payable, fair value disclosure	1,167	1,164
Carrying Amount \| ABL Facility and Other Debt
Liabilities:
Notes payable, fair value disclosure	275	85
Estimated Fair Value
Assets:
Cash and cash equivalents	38	118
Investments in equity securities	69	107
Available-for-sale debt securities	182	179
Trading securities	5	5
Estimated Fair Value \| Senior Notes \| Senior Notes at 6.875% Due 2028
Liabilities:
Notes payable, fair value disclosure	470	389
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Liabilities:
Notes payable, fair value disclosure	1,114	1,917
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 8% Due 2027
Liabilities:
Notes payable, fair value disclosure	679	631
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Liabilities:
Notes payable, fair value disclosure	1,767	1,633
Estimated Fair Value \| Senior Secured Notes \| Senior Notes at 6% Due 2029
Liabilities:
Notes payable, fair value disclosure	580	751
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Liabilities:
Notes payable, fair value disclosure	1,287	1,166
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 4.75%, Due 2031
Liabilities:
Notes payable, fair value disclosure	834	766
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 10.875% Due 2032
Liabilities:
Notes payable, fair value disclosure	1,047
Estimated Fair Value \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Liabilities:
Notes payable, fair value disclosure	812	720
Estimated Fair Value \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Liabilities:
Notes payable, fair value disclosure	781	615
Estimated Fair Value \| ABL Facility and Other Debt
Liabilities:
Notes payable, fair value disclosure	$ 275	$ 85

Long Term Debt - Schedule of Early Redemption Prices on 10.875% Senior Secured Notes Due 2032 (Details) - Senior Secured Notes [Member] - Senior Secured Notes at 10.875%, Due 2032	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument, Redemption [Line Items]
Debt instrument redemption price percentage	105.438%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2027
Debt Instrument, Redemption Period, End Date	Feb. 14, 2028
Debt Instrument, Redemption, Period Two
Debt Instrument, Redemption [Line Items]
Debt instrument redemption price percentage	102.719%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2028
Debt Instrument, Redemption Period, End Date	Feb. 14, 2029
Debt Instrument, Redemption, Period Three
Debt Instrument, Redemption [Line Items]
Debt instrument redemption price percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Feb. 15, 2029
Debt Instrument, Redemption Period, End Date	Jan. 14, 2032

Equity Investments

12 Months Ended

Dec. 31, 2023

Equity Method Investments and Joint Ventures [Abstract]

Equity Investments

13. EQUITY INVESTMENTS

On July 30, 2021, the Company sold its unconsolidated equity interests in Macon Healthcare, LLC, a joint venture with certain subsidiaries of HCA representing two hospitals in Macon, Georgia, in which the Company held a 38% interest. The Company received $110 million in cash in connection with the sale of its equity interests and, as a result, recognized a pre-tax gain of approximately $39 million on the sale of equity interests in Macon Healthcare, LLC during the year ended December 31, 2021.

On December 31, 2016, the Company sold 80% of its ownership interest in the legal entity that owned and operated its home care agency business. As part of the divestiture of its controlling interest in the home care agency business, the Company recorded an equity method investment representing its remaining 20% ownership. Since December 31, 2016 and primarily in conjunction with the divestiture of hospitals, the Company has divested its remaining 20% ownership in certain home care agency businesses.

In March 2005, the Company began purchasing items, primarily medical supplies, medical equipment and pharmaceuticals, under an agreement with HealthTrust Purchasing Group, L.P. (“HealthTrust”), a group purchasing organization in which the Company is a noncontrolling partner. Effective October 1, 2022, HealthTrust completed the sale of a majority interest in CoreTrust Holdings, LLC (“CoreTrust”) to a third party. Proceeds for the sale of interest in CoreTrust were distributed to members of HealthTrust and the Company received approximately $121 million in connection with such distribution during the year ended December 31, 2022. A gain of approximately $119 million was recognized associated with this transaction as included in the line item “Gain from CoreTrust Transaction” within the consolidated statements of (loss) income. As of December 31, 2023, the Company had a 12.6% ownership interest in HealthTrust.

The Company’s investment in all of its unconsolidated affiliates was $170 million and $155 million at December 31, 2023 and 2022, respectively, and is included in other assets, net in the accompanying consolidated balance sheets. Included in the Company’s results of operations is the Company’s equity in pre-tax earnings from its investments in unconsolidated affiliates, which was $8 million, $14 million and $22 million for the years ended December 31, 2023, 2022 and 2021, respectively.

Consolidated Balance Sheets - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 38	$ 118
Patient accounts receivable	2,231	2,040
Supplies	328	353
Prepaid income taxes	76	99
Prepaid expenses and taxes	260	237
Other current assets	275	235
Total current assets	3,208	3,082
Property and equipment
Land and improvements	474	497
Buildings and improvements	5,951	6,038
Equipment and fixtures	3,086	3,104
Property and equipment	9,511	9,639
Less accumulated depreciation and amortization	(4,304)	(4,274)
Property and equipment, net	5,207	5,365
Goodwill	3,958	4,166
Deferred income taxes	29	49
Other assets, net of accumulated amortization of $1,518 and $1,392 at December 31, 2023 and 2022, respectively	2,053	2,007
Total assets	14,455	14,669
Current liabilities:
Current maturities of long-term debt	21	21
Current operating lease liabilities	124	148
Accounts payable	912	773
Accrued liabilities:
Employee compensation	571	637
Accrued interest	160	189
Other	354	418
Total current liabilities	2,142	2,186
Long-term debt	11,466	11,614
Deferred income taxes	369	354
Long-term operating lease liabilities	563	605
Other long-term liabilities	739	644
Total liabilities	15,279	15,403
Redeemable noncontrolling interests in equity of consolidated subsidiaries	323	541
Commitments and contingencies (Note 15)
Community Health Systems, Inc. stockholders’ deficit:
Common stock, $.01 par value per share, 300,000,000 shares authorized; 136,774,911 shares issued and outstanding at December 31, 2023, and 134,703,717 shares issued and outstanding at December 31, 2022	1	1
Additional paid-in capital	2,185	2,084
Accumulated other comprehensive loss	(14)	(21)
Accumulated deficit	(3,564)	(3,431)
Total Community Health Systems, Inc. stockholders’ deficit	(1,392)	(1,367)
Noncontrolling interests in equity of consolidated subsidiaries	245	92
Total stockholders’ deficit	(1,147)	(1,275)
Total liabilities and stockholders’ deficit	$ 14,455	$ 14,669

Long-Term Debt - Schedule of Early Redemption Prices on 8% Senior Secured Notes due 2026 (Details) - Senior Secured Notes at 8%, Due 2026 - Senior Secured Notes	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument Redemption Price Percentage	102.00%
Debt Instrument, Redemption Period, Start Date	Mar. 15, 2023
Debt Instrument, Redemption Period, End Date	Mar. 14, 2024
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Mar. 15, 2024
Debt Instrument, Redemption Period, End Date	Mar. 14, 2026

Consolidated Statements of (Loss) Income (Parenthetical) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Interest income	$ 2	$ 2	$ 3

Fair Value

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

FAIR VALUE

8. FAIR VALUE

Fair Value Hierarchy

The inputs used to measure fair value are classified into the following fair value hierarchy:


Level 1:		Quoted market prices in active markets for identical assets or liabilities.
Level 2:		Observable market-based inputs or unobservable inputs that are corroborated by market data.
Level 3:		Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Level 3 includes values determined using pricing models, discounted cash flow methodologies, or similar techniques reflecting the Company’s own assumptions.

In instances where the determination of the fair value hierarchy measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment of factors specific to the asset or liability. Transfers between levels within the fair value hierarchy are recognized by the Company on the date of the change in circumstances that requires such transfer. There were no transfers between levels during the years ended December 31, 2023 or 2022.

The following table sets forth, by level within the fair value hierarchy, the financial assets recorded at fair value on a recurring basis as of December 31, 2023 and 2022 (in millions):


	December 31, 2023		Level 1		Level 2		Level 3
Investments in equity securities	$	69	$	69	$	—	$	—
Available-for-sale debt securities		182		—		182		—
Trading securities		5		—		5		—
Total assets	$	256	$	69	$	187	$	—


	December 31, 2022		Level 1		Level 2		Level 3
Investments in equity securities	$	107	$	107	$	—	$	—
Available-for-sale debt securities		179		—		179		—
Trading securities		5		—		5		—
Total assets	$	291	$	107	$	184	$	—

Investments in Equity Securities, Available-for-Sale Debt Securities and Trading Securities

Investments in equity securities classified as Level 1 are measured using quoted market prices. Level 2 available-for-sale debt securities and trading securities primarily consist of bonds and notes issued by the United States government and its agencies and domestic and foreign corporations. The estimated fair values of these securities are determined using various valuation techniques, including a multi-dimensional relational model that incorporates standard observable inputs and assumptions such as benchmark yields, reported trades, broker/dealer quotes, issuer spreads, benchmark securities, bids/offers and other pertinent reference data.

Supplemental information regarding the Company’s available-for-sale debt securities (all of which had no withdrawal restrictions) is set forth in the table below (in millions):


			Gross		Gross			Estimated
	Amortized		Unrealized		Unrealized			Fair
	Cost		Gains		Losses			Values
As of December 31, 2023:
Government	$	118	$	—	$	(10	)	$	108
Corporate		65		—		(6	)		59
Mortgage and asset-backed securities		16		—		(1	)		15
Total available-for-sale debt securities	$	199	$	—	$	(17	)	$	182


			Gross		Gross			Estimated
	Amortized		Unrealized		Unrealized			Fair
	Cost		Gains		Losses			Values
As of December 31, 2022:
Government	$	107	$	—	$	(11	)	$	96
Corporate		69		—		(9	)		60
Mortgage and asset-backed securities		25		—		(2	)		23
Total available-for-sale debt securities	$	201	$	—	$	(22	)	$	179

As of December 31, 2023 and 2022, investments with aggregate estimated fair values of approximately $145 million (306 investments) and $169 million (348 investments), respectively, generated the gross unrealized losses disclosed in the above table. At each reporting date, the Company performs an evaluation of impaired securities to determine if the unrealized losses are other-than-temporary. This evaluation considers a number of factors including, but not limited to, the length of time and extent to which the fair value has been less than cost, and management’s ability and intent to hold the securities until fair value recovers. Based on the results of this evaluation, management concluded that as of December 31, 2023, there were no other-than-temporary losses related to available-for-sale debt securities. The recent declines in value of the securities and/or length of time they have been below cost, as well as the Company’s ability and intent to hold the securities for a reasonable period of time sufficient for a projected recovery of fair value, have caused management to conclude that the securities, that have generated gross unrealized losses, were not other-than-temporarily impaired. Management will continue to monitor and evaluate the recoverability of the Company’s available-for-sale debt securities.

The contractual maturities of debt-based securities held by the Company as of December 31, 2023 and 2022, excluding mutual fund holdings, are set forth in the table below (in millions). Expected maturities will differ from contractual maturities because the issuers of the debt securities may have the right to prepay their obligations without prepayment penalties.


	December 31, 2023				December 31, 2022
	Amortized		Estimated		Amortized		Estimated
	Cost		Fair Values		Cost		Fair Values
Within 1 year	$	19	$	19	$	13	$	13
After 1 year and through year 5		63		62		74		70
After 5 years and through year 10		63		57		56		48
After 10 years		54		44		58		48

Gross realized gains and losses on sales of available-for-sale debt securities are summarized in the table below (in millions):


	Year Ended December 31,
	2023			2022			2021
Realized gains	$	—		$	—		$	1
Realized losses		(2	)		(2	)		(1	)

Other investment income, which includes interest and dividends, related to all investment securities was $7 million, $6 million and $5 million for the years ended December 31, 2023, 2022 and 2021, respectively.

Net losses and gains recognized during the years ended December 31, 2023, 2022 and 2021 for investments in equity securities, which are broken out between investments sold during the year and investments held at the end of the year, are summarized in the table below (in millions):


	Year Ended December 31,
	2023			2022			2021
Net gains and (losses) recognized during the year on equity securities	$	11		$	(28	)	$	20
Less: Net (losses) and gains recognized during the year on equity securities sold during the year		(5	)		(2	)		13
Unrealized gains and (losses) recognized during the year on equity securities held at the end of year	$	16		$	(26	)	$	7

Stockholders' Deficit - Schedule of Impact of Noncontrolling Interest to Stockholders' Deficit (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Equity [Abstract]
Net Income (Loss)	$ (133)	$ 46	$ 230
Net increase (decrease) in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests	5	(6)	17
Net transfers to the noncontrolling interests	5	(6)	17
Change to Community Health Systems, Inc. stockholders' deficit from net (loss) income attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$ (128)	$ 40	$ 247

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

Long-Term Debt - ABL Facility - Additional Information (Details) - USD ($)		12 Months Ended
	Nov. 22, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Interest paid on borrowings		$ 801,000,000	$ 835,000,000	$ 778,000,000
Amended and Restated ABL Credit Agreement
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 1,000,000,000.0
Line of credit facility, excess availability		637,000,000
Line of credit outstanding amount		247,000,000
Aggregate principal amount for springing maturity	350,000,000
Amended and Restated ABL Credit Agreement \| ABL Facility Customary Covenants
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 95,000,000
Debt instrument variable interest rate	10.00%
Amended and Restated ABL Credit Agreement \| Minimum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.25%
Amended and Restated ABL Credit Agreement \| Maximum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.375%
Amended and Restated ABL Credit Agreement \| Base Rate
Debt Instrument [Line Items]
Percentage of the maximum commitment of excess availability, one	0.75%
Percentage of the maximum commitment of excess availability, two	1.00%
Percentage of the maximum commitment of excess availability, three	1.25%
Amended and Restated ABL Credit Agreement \| Federal Reserve’s Secured Overnight Financing Rate
Debt Instrument [Line Items]
Percentage of the maximum commitment of excess availability, one	1.75%
Percentage of the maximum commitment of excess availability, two	2.00%
Percentage of the maximum commitment of excess availability, three	2.25%
Letter of Credit \| Amended and Restated ABL Credit Agreement
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 200,000,000
Line of credit outstanding amount		$ 81,000,000

Leases - Commitments Relating to Noncancellable Lease Obligations (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Operating Leases
2024	$ 181
2025	144
2026	118
2027	92
2028	75
Thereafter	467
Total minimum future payments	1,077
Less: Imputed interest	(390)
Total liabilities	687
Less: Current portion	(124)	$ (148)
Long-term liabilities	563	605
Finance Leases
2024	16
2025	15
2026	16
2027	16
2028	16
Thereafter	472
Total minimum future payments	551
Less: Imputed interest	(335)
Total liabilities	216
Less: Current portion	(2)	(3)
Long-term liabilities	214	$ 220
Financing Obligations
2024	13
2025	13
2026	13
2027	13
2028	14
Thereafter	59
Total minimum future payments	125
Less: Imputed interest	26
Total liabilities	151
Less: Current portion	(3)
Long-term liabilities	$ 148

Goodwill and Other Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

4. GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

The changes in the carrying amount of goodwill for the years ended 2023 and 2022 are as follows (in millions):


Balance, beginning balance	2023			2022
Goodwill	$	6,980		$	7,033
Accumulated impairment losses		(2,814	)		(2,814	)
		4,166			4,219
Goodwill acquired as part of acquisitions during current year		23			11
Goodwill allocated to hospitals divested or held-for-sale		(231	)		(64	)

Balance, end of year
Goodwill		6,772			6,980
Accumulated impairment losses		(2,814	)		(2,814	)
	$	3,958		$	4,166

Goodwill is allocated to each identified reporting unit, which is defined as an operating segment or one level below the operating segment (referred to as a component of the entity). Management has determined that the Company’s operating segment meets the criteria to be classified as a reporting unit. At December 31, 2023, after giving effect to the 2023 acquisition and divestiture activity, the Company had approximately $3.958 billion of goodwill recorded.

Goodwill is evaluated for impairment annually and when an event occurs or circumstances change that, more likely than not, reduce the fair value of the reporting unit below its carrying value. The Company performed its last annual goodwill impairment evaluation during the fourth quarter of 2023 using an October 31, 2023 measurement date, which indicated no impairment.

The Company estimates the fair value of the reporting unit using both a discounted cash flow model as well as a market multiple model. The cash flow forecasts are adjusted by an appropriate discount rate based on the Company’s estimate of a market participant’s weighted-average cost of capital. These models are both based on the Company’s best estimate of future revenues and operating costs and are reconciled to the Company’s consolidated market capitalization, with consideration of the amount a potential acquirer would be required to pay, in the form of a control premium, in order to gain sufficient ownership to set policies, direct operations and control management decisions.

The determination of fair value in the Company’s goodwill impairment analysis is based on an estimate of fair value for the reporting unit utilizing known and estimated inputs at the evaluation date. Some of those inputs include, but are not limited to, the most recent price of the Company’s common stock and fair value of long-term debt, the Company’s recent financial results, estimates of future revenue and expense growth, estimated market multiples, expected capital expenditures, income tax rates, costs of invested capital and a discount rate.

Future estimates of fair value could be adversely affected if the actual outcome of one or more of the assumptions described above changes materially in the future, including as a result of any decline in the Company’s stock price and the fair value of its long-term debt, an increase in the volatility of the Company’s stock price and the fair value of its long-term debt, lower-than-expected hospital volumes and/or net operating revenues, higher market interest rates, increased operating costs or other adverse impacts on the Company’s financial results. Such changes impacting the calculation of fair value could result in a material impairment charge in the future.

The determination of fair value of the Company’s hospital operations reporting unit as part of its goodwill impairment measurement represents a Level 3 fair value measurement in the fair value hierarchy due to its use of internal projections and unobservable measurement inputs.

Intangible Assets

During the year ended December 31, 2023, the Company acquired goodwill and a definite-lived intangible asset for the acquisition of an assembled workforce. No intangible assets other than goodwill were acquired during the year ended 2022. The gross carrying amount of the Company’s other intangible assets subject to amortization was $27 million and $4 million at December 31, 2023 and 2022, respectively, and the net carrying amount was $20 million and $2 million at December 31, 2023 and 2022, respectively. The carrying amount of the Company’s other intangible assets not subject to amortization was $41 million and $50 million at December 31, 2023 and 2022, respectively. Other intangible assets are included in other assets, net on the Company’s consolidated balance sheets. The Company’s intangible assets include an assembled workforce and various contract-based intangible assets related to operating licenses, management contracts, or non-compete agreements entered into in connection with prior acquisitions.

The weighted-average remaining amortization period for the intangible assets subject to amortization is approximately three years. There are no expected residual values related to these intangible assets. Amortization expense on these intangible assets was $5 million, $1 million and less than $1 million during the years ended December 31, 2023, 2022 and 2021, respectively. Amortization expense on intangible assets is estimated to be $8 million, $8 million and $4 million in 2024, 2025 and 2026, respectively.

The gross carrying amount of capitalized software for internal use was approximately $959 million and $968 million at December 31, 2023 and 2022, respectively, and the net carrying amount was approximately $144 million and $170 million at December 31, 2023 and 2022, respectively. The estimated amortization period for capitalized internal-use software is generally three years. There is no expected residual value for capitalized internal-use software. At December 31, 2023, there were approximately $68 million of capitalized costs for internal-use software that is currently in the development stage and will begin amortization once the software project is complete and ready for its intended use. Amortization expense on capitalized internal-use software was $80 million, $85 million and $108 million during the years ended December 31, 2023, 2022 and 2021, respectively. Amortization expense on capitalized internal-use software is estimated to be $57 million in 2024, $39 million in 2025, $27 million in 2026, $12 million in 2027, $7 million in 2028 and $2 million thereafter.

Consolidated Statements of (Loss) Income - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Net operating revenues	$ 12,490	$ 12,211	$ 12,368
Operating costs and expenses:
Salaries and benefits	5,415	5,330	5,242
Supplies	1,993	1,975	2,042
Other operating expenses	3,388	3,336	2,958
Lease cost and rent	319	317	308
Pandemic relief funds		(173)	(148)
Depreciation and amortization	505	534	540
Impairment and (gain) loss on sale of businesses, net	(87)	71	24
Total operating costs and expenses	11,533	11,390	10,966
Income from operations	957	821	1,402
Interest expense, net of interest income of $2 in both 2023 and 2022 and $3 in 2021	830	858	885
(Gain) loss from early extinguishment of debt	(72)	(253)	79
Gain on sale of equity interests in Macon Healthcare, LLC			(39)
Gain from CoreTrust Transaction		(119)
Equity in earnings of unconsolidated affiliates	(8)	(14)	(22)
(Loss) income before income taxes	207	349	499
Provision for income taxes	191	170	131
Net income	16	179	368
Less: Net income attributable to noncontrolling interests	149	133	138
Net (loss) income attributable to Community Health Systems, Inc. stockholders	$ (133)	$ 46	$ 230
(Loss) earnings per share attributable to Community Health Systems, Inc. stockholders:
Basic	$ (1.02)	$ 0.35	$ 1.82
Diluted	$ (1.02)	$ 0.35	$ 1.76
Weighted-average number of shares outstanding:
Basic	130,445,677	128,808,387	126,754,852
Diluted	130,445,677	130,060,319	130,597,410

Long-Term Debt - Schedule of Early Redemption Prices on 8% Senior Secured Notes due 2027 (Details) - Senior Secured Notes at 8% Due 2027 - Senior Secured Notes	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument Redemption Price Percentage	102.00%
Debt Instrument, Redemption Period, Start Date	Dec. 15, 2023
Debt Instrument, Redemption Period, End Date	Dec. 14, 2024
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Dec. 15, 2024
Debt Instrument, Redemption Period, End Date	Dec. 14, 2027

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Restricted Stock Units, Activity (Details) - Restricted Stock Units (RSUs) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Unvested Shares	512,360	486,598	613,739
Granted, Shares	365,037	176,820	173,664
Vested, Shares	(101,471)	(151,058)	(300,805)
Ending Balance, Unvested Shares	775,926	512,360	486,598
Beginning of Period, Weighted Average Grant Date Fair Value	$ 7.54	$ 6.17	$ 4.89
Granted, Weighted Average Grant Date Fair Value	6.15	9.66	8.81
Vested, Weighted Average Grant Date Fair Value	7.75	5.63	5.09
End of Period, Weighted Average Grant Date Fair Value	$ 6.86	$ 7.54	$ 6.17

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 1D
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Section 35
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (a)(2)
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 2
-Subparagraph (a)(3)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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-Subparagraph (c)(1)(iv)
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2003/role/disclosureRef
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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Acquisitions, Divestitures and Closures - Other - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($) Item	Dec. 31, 2023 Item	Feb. 28, 2023 Item
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment of long-lived assets sold \| $	$ 71
AllianceHealth Clinton
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charge recorded on the sale or closure of hospitals \| $	$ 1
AllianceHealth Clinton \| Clinton, Oklahoma
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	56
Davis Regional Medical Center \| Statesville, North Carolina
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			(144)
AllianceHealth Woodward
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds		87
Lake Norman Regional Medical Center \| Mooresville, North Carolina
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds			123

Earnings Per Share - Schedule of Antidilutive Securities (Details) - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Abstract]
Employee stock options and restricted stock awards excluded from computation of earnings per share amount	6,210,811	4,406,764	774,981

Long-Term Debt - Schedule of Early Redemption Prices on 6.0% Senior Notes Due 2029 (Details) - 6% Senior Secured Notes due 2029 - Senior Secured Notes	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period One
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	103.00%
Debt Instrument, Redemption Period, Start Date	Jan. 15, 2024
Debt Instrument, Redemption Period, End Date	Jan. 14, 2025
Debt Instrument, Redemption, Period Two
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	101.50%
Debt Instrument, Redemption Period, Start Date	Jan. 15, 2025
Debt Instrument, Redemption Period, End Date	Jan. 14, 2026
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption [Line Items]
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Jan. 15, 2026
Debt Instrument, Redemption Period, End Date	Jan. 14, 2029

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Effect on income before income taxes	$ (22)	$ (20)	$ (25)
Effect on net income	$ (17)	$ (15)	$ (20)

Basis of Presentation and Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

1. BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Cash Equivalents. The Company considers highly liquid investments with original maturities of three months or less to be cash equivalents.

Supplies. Supplies, principally medical supplies, are stated at the lower of cost (first-in, first-out basis) or market.

Revenue Recognition.

Net Operating Revenues


	Year Ended December 31,
	2023		2022		2021
Medicare	$	2,484	$	2,547	$	2,650
Medicare Managed Care		2,103		1,968		1,861
Medicaid		1,790		1,807		1,671
Managed Care and other third-party payors		5,978		5,806		6,076
Self-pay		135		83		110
Total	$	12,490	$	12,211	$	12,368

Patient Accounts Receivable

Charity Care

Other Comprehensive Loss. Other comprehensive loss is the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources.

COVID-19 Pandemic. Throughout the acute phase of the COVID-19 pandemic that began in 2020, federal and state governments passed legislation, promulgated regulations and took other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients during the public health emergency and to provide financial relief. Various stimulus laws, including the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) and the American Rescue Plan Act of 2021 (the “ARPA”), among others, authorized significant funding to be distributed to eligible healthcare providers through the Public Health and Social Services Emergency Fund (the “PHSSEF”). PHSSEF payments were intended to compensate healthcare providers for lost revenues and incremental expenses incurred in response to the COVID-19 pandemic and are not required to be repaid, provided that recipients attest to and comply with certain terms and conditions, including audit and reporting requirements. Various state and local programs also exist to provide relief, either independently or through distribution of monies received via the CARES Act and other enacted federal legislation.

Consolidated Statements of Cash Flows - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net income	$ 16	$ 179	$ 368
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and amortization	505	534	540
Deferred income taxes	35	165	170
Stock-based compensation expense	22	20	25
Impairment and (gain) loss on sale of businesses, net	(87)	71	24
(Gain) loss from early extinguishment of debt	(72)	(253)	79
Gain on sale of equity interests in Macon Healthcare, LLC			(39)
Gain from CoreTrust Transaction		(119)
Other non-cash expenses, net	181	182	78
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:
Patient accounts receivable	(193)	22	(136)
Supplies, prepaid expenses and other current assets	(82)	(128)	1
Repayment/derecognition of Medicare accelerated payments			(1,081)
Accounts payable, accrued liabilities and income taxes	(50)	(158)	16
Other	(65)	(215)	(176)
Net cash provided by (used in) operating activities	210	300	(131)
Cash flows from investing activities:
Acquisitions of facilities and other related businesses	(38)	(9)	(3)
Purchases of property and equipment	(467)	(415)	(469)
Proceeds from disposition of hospitals and other ancillary operations	432	89	17
Proceeds from sale of property and equipment	28	38	10
Purchases of available-for-sale debt securities and equity securities	(137)	(114)	(171)
Proceeds from sales of available-for-sale debt securities and equity securities	232	110	102
Purchases of investments in unconsolidated affiliates	(11)	(19)	(7)
Proceeds from sale of equity interests in Macon Healthcare, LLC			110
Distribution of CoreTrust Transaction proceeds		121
Increase in other investments	(65)	(60)	(113)
Net cash used in investing activities	(26)	(259)	(524)
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements	(4)	(8)	(5)
Deferred financing costs and other debt-related costs	(3)	(74)	(313)
Proceeds from noncontrolling investors in joint ventures	5	13
Redemption of noncontrolling investments in joint ventures	(1)	(5)	(19)
Distributions to noncontrolling investors in joint ventures	(141)	(125)	(121)
Other borrowings	39	48	60
Issuance of long-term debt	989	1,535	4,310
Proceeds from ABL Facility	3,176	542
Repayments of long-term indebtedness	(4,324)	(2,356)	(4,426)
Net cash used in financing activities	(264)	(430)	(514)
Net change in cash and cash equivalents	(80)	(389)	(1,169)
Cash and cash equivalents at beginning of period	118	507	1,676
Cash and cash equivalents at end of period	38	118	507
Supplemental disclosure of cash flow information:
Interest payments	(801)	(835)	(778)
Income tax (payments) refunds, net	$ (91)	$ (6)	$ (4)

Long-Term Debt - 6% Senior Secured Notes, Due 2029 - Additional Information - (Details) - Senior Notes - USD ($) $ in Millions		12 Months Ended
	Dec. 28, 2020	Dec. 31, 2023
6% Senior Secured Notes due 2029
Debt instrument aggregate principal amount	$ 900
Debt instrument, maturity date	Jan. 15, 2029
Debt instrument stated interest rate	6.00%
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Debt instrument redemption description		plus a “make-whole” premium, as described in the indenture governing the 6% Senior Secured Notes due 2029.
Maximum principal redeemable using proceeds from a public equity offering, as a percentage of principal amount	40.00%
6% Senior Secured Notes due 2029 \| Debt Instrument, Redemption, Period One
Debt instrument redemption price percentage	100.00%
6% Senior Secured Notes due 2029 \| Debt Instrument, Redemption, Period Two
Debt instrument redemption price percentage	106.00%
6% Senior Secured Notes due 2029 and 5.625% Senior Secured Notes due 2027
Debt instrument, repurchase amount	$ 2,579

Employee Benefit Plans

12 Months Ended

Dec. 31, 2023

Retirement Benefits [Abstract]

Employee Benefit Plans

10. EMPLOYEE BENEFIT PLANS

The Company maintains various benefit plans, including defined contribution plans, defined benefit plans and deferred compensation plans, for which certain of the Company’s subsidiaries are the plan sponsors. The CHS/Community Health Systems, Inc. Retirement Savings Plan is a defined contribution plan that covers the majority of the Company’s employees. Employees at locations whose employment is covered by collective bargaining agreements are generally eligible to participate in the CHS/Community Health Systems, Inc. Standard 401(k) Plan. Total expense to the Company under the 401(k) plans was $64 million, $70 million and $65 million for the years ended December 31, 2023, 2022 and 2021, respectively, and is recorded in salaries and benefits expense in the consolidated statements of (loss) income.

The Company maintains unfunded deferred compensation plans that allow participants to defer receipt of a portion of their compensation. The liability for the deferred compensation plans was $123 million and $127 million as of December 31, 2023 and 2022, respectively, and is included in other long-term liabilities in the consolidated balance sheets. Assets designated to pay benefits under these plans are discussed below.

The Company provides an unfunded Supplemental Executive Retirement Plan (“SERP”) for certain members of its executive management. The Company uses a December 31 measurement date for the benefit obligations and a January 1 measurement date for its net periodic costs for the SERP. Variances from actuarially assumed rates will result in increases or decreases in benefit obligations and net periodic cost in future periods. Benefits expense under the SERP was $8 million for the year ended December 31, 2023 and $11 million for both of the years ended December 31, 2022 and 2021. The accrued benefit liability for the SERP totaled $42 million and $91 million at December 31, 2023 and 2022, respectively. The weighted-average assumptions used in determining net periodic cost for the year ended December 31, 2023 were a discount rate of 5.1% and an annual salary increase of 3.0%. The weighted-average assumptions used in determining net periodic cost for the year ended December 31, 2022 were a discount rate of 2.7% and an annual salary increase of 3.0%.

During 2021 and 2023, certain members of executive management of the Company that were participants in the SERP retired and met the requirements for payout of their SERP retirement benefit. The SERP payout provisions require payment to the participant in an actuarially determined lump sum amount six months after the participant retires from the Company. There were no material settlement losses during the years ended December 31, 2023, 2022 and 2021.

As of December 31, 2023, the Company had assets of $126 million in a non-qualified plan trust generally designated to pay benefits of the deferred compensation plans and the SERP, consisting of equity securities of $15 million and company-owned life insurance contracts of $111 million. As of December 31, 2022, the Company had assets of $181 million in a non-qualified plan trust generally designated to pay benefits of the deferred compensation plans and the SERP, consisting of equity securities of $46 million and company-owned life insurance contracts of $135 million.

The Company maintains the CHS/Community Health Systems, Inc. Retirement Income Plan (“Pension Plan”), which is a defined benefit, non-contributory pension plan that covers certain employees at three of its formerly owned hospitals. The Pension Plan provides benefits to covered individuals satisfying certain age and service requirements. Employer contributions to the Pension Plan are in accordance with the minimum funding requirements of the Employee Retirement Income Security Act of 1974, as amended. The Company does not expect to make contributions to the Pension Plan in 2024.

In September 2021, the lifetime obligation of the Pension Plan with respect to certain participants was transferred to a third-party insurer via an irrevocable annuity contract. The third-party insurer began paying benefits to the participants as of November 1, 2021. This action resulted in a partial plan settlement and recognition of a less than $1 million settlement charge during the year ended December 31, 2021.

The Company uses a December 31 measurement date for the benefit obligations and a January 1 measurement date for its net periodic costs for the Pension Plan. Variances from actuarially assumed rates will result in increases or decreases in benefit obligations, net periodic cost and funding requirements in future periods. Benefits expense under the Pension Plan was less than $1 million for each of the years ended December 31, 2023, 2022 and 2021, inclusive of the aforementioned partial plan settlement during the year ended December 31, 2021. The accrued benefit liability for the Pension Plan totaled $2 million at both December 31, 2023 and 2022, and is included in other long-term liabilities in the consolidated balance sheets. The weighted-average assumptions used for determining the net periodic cost for the years ended December 31, 2023 and 2022 were discount rates of 5.2% and 2.8%, respectively, and the expected long-term rates of return on assets of 5.5% and 4.3%, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
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-Name Accounting Standards Codification
-Section 55
-Paragraph 17
-Publisher FASB
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
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-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
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-Paragraph 1
-Subparagraph (d)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Topic 715
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-Paragraph 1
-Subparagraph (l)
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-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

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-Topic 715
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-URI https://asc.fasb.org//715/tableOfContent

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-Topic 715
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-Name Accounting Standards Codification
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-Subparagraph (d)(iii)
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-Topic 715
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-Paragraph 2
-Publisher FASB
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-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480266/715-60-50-3

+ Details

Basis of Presentation and Significant Accounting Policies - Schedule of Net Operating Revenues (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	$ 12,490	$ 12,211	$ 12,368
Medicare
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	2,484	2,547	2,650
Medicare Managed Care
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	2,103	1,968	1,861
Medicaid
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	1,790	1,807	1,671
Managed Care and Other Third Party Payors
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	5,978	5,806	6,076
Self-Pay
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Net operating revenues	$ 135	$ 83	$ 110

- Definition

Amount of revenue recognized from goods sold, services rendered, insurance premiums, or other activities that constitute an earning process. Includes, but is not limited to, investment and interest income before deduction of interest expense when recognized as a component of revenue, and sales and trading gain (loss).

+ References

+ Details

Accounting for Stock-Based Compensation - Schedule of Share-based Payment Awards, Stock Options, Valuation Assumptions (Details) - Employee Stock Option	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	87.30%
Expected volatility, minimum		84.30%	84.30%
Expected volatility, maximum		87.50%	88.90%
Expected term	6 years
Risk-free interest rate	4.20%
Risk-free interest rate, minimum		1.50%	0.30%
Risk-free interest rate, maximum		1.60%	0.90%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term		3 years	3 years
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term		6 years	6 years

Long-Term Debt - 5.625% Senior Secured Notes, Due 2027 - Additional Information (Details) - Senior Secured Notes - USD ($)		12 Months Ended
	Dec. 28, 2020	Dec. 31, 2023
5⅝% Senior Secured Notes due 2027
Debt Instrument [Line Items]
Debt instrument, offering date		Dec. 28, 2020
Debt instrument, maturity date		Mar. 15, 2027
Debt instrument aggregate principal amount	$ 1,900,000,000
Minimum period notice for redemption of debt	15 days
5⅝% Senior Secured Notes due 2027 \| Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt instrument redemption price percentage		101.406%
5⅝% Senior Secured Notes due 2027 \| Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt instrument redemption price percentage		102.813%
6?% Senior Secured Notes due 2023
Debt Instrument [Line Items]
Debt instrument aggregate principal amount	$ 2,579,000,000

Fair Value - Additional Information (Details)	12 Months Ended
Fair Value - Additional Information (Details)	Dec. 31, 2023 USD ($) Item	Dec. 31, 2022 USD ($) Item	Dec. 31, 2021 USD ($)
Fair Value Disclosures [Line Items]
Fair value, assets, level 1 to level 2 transfers, amount	$ 0	$ 0
Fair value, assets, level 2 to level 1 transfers, amount	0	0
Fair value, liabilities, level 1 to level 2 transfers, amount	0	0
Fair value, liabilities, level 2 to level 1 transfers, amount	0	0
Available-for-sale Securities, Continuous Unrealized Loss Position, Fair Value	$ 145,000,000	$ 169,000,000
Available-for-sale, Securities in Unrealized Loss Positions, Qualitative Disclosure, Number of Positions \| Item	306	348
Other Investment Income
Fair Value Disclosures [Line Items]
Investment Income, Interest and Dividend	$ 7,000,000	$ 6,000,000	$ 5,000,000
Available-for-sale Securities
Fair Value Disclosures [Line Items]
Other than Temporary Impairment, Credit Losses Recognized in Earnings, Credit Losses on Debt Securities Held	$ 0

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accumulated amortization	$ 1,518	$ 1,392
Preferred stock, par value per share	$ 0.01	$ 0.01
Preferred stock, shares authorized	100,000,000	100,000,000
Preferred stock, shares issued	0	0
Common stock, par value per share	$ 0.01	$ 0.01
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares issued	136,774,911	134,703,717
Common stock, shares outstanding	136,774,911	134,703,717

Leases - Components of Lease Cost and Rent Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating lease cost	$ 211	$ 211	$ 196
Short-term rent expense	90	87	92
Variable lease cost	23	24	25
Sublease income	(5)	(5)	(5)
Total operating lease cost	319	317	308
Finance lease cost:
Amortization of ROU assets	13	13	9
Interest on finance lease liabilities	13	15	9
Total finance lease cost	$ 26	$ 28	$ 18

Acquisitions, Divestitures and Closures (Tables)

12 Months Ended

Dec. 31, 2023

Acquisitions Divestitures And Closures [Abstract]

Schedule of Divestitures


Hospital	Buyer	City, State	Licensed Beds	Effective Date
2023 Divestitures:
Greenbrier Valley Medical Center	Vandalia Health, Inc.	Ronceverte, WV	122	January 1, 2023
Plateau Medical Center	Vandalia Health, Inc.	Oak Hill, WV	25	April 1, 2023
Medical Center of South Arkansas	SARH Holdings, Inc.	El Dorado, AR	166	July 1, 2023
Lutheran Rehabilitation Hospital	Select Medical Corporation	Fort Wayne, IN	36	September 1, 2023
AllianceHealth Ponca City	Integris Health	Ponca City, OK	140	November 1, 2023
AllianceHealth Woodward	Integris Health	Woodward, OK	87	November 1, 2023
Bravera Health Brooksville	Tampa General Hospital	Brooksville, FL	120	December 1, 2023
Bravera Health Spring Hill	Tampa General Hospital	Spring Hill, FL	124	December 1, 2023
Bravera Health Seven Rivers	Tampa General Hospital	Crystal River, FL	128	December 1, 2023

2022 Divestitures:
AllianceHealth Seminole	SSM Health Care of Oklahoma, Inc.	Seminole, OK	32	July 1, 2022

2021 Divestitures:
Lea Regional Medical Center	Covenant Health System	Hobbs, NM	84	January 1, 2021
Tennova Healthcare - Tullahoma	Vanderbilt University Medical Center	Tullahoma, TN	135	January 1, 2021
Tennova Healthcare - Shelbyville	Vanderbilt University Medical Center	Shelbyville, TN	60	January 1, 2021
Northwest Mississippi Medical Center	Delta Health System	Clarksdale, MS	181	February 1, 2021
AllianceHealth Midwest	SSM Health Care of Oklahoma, Inc.	Midwest City, OK	255	April 1, 2021

Schedule of Balance Sheet Items Classified as Held for Sale


	December 31,
	2023			2022
Other current assets	$	6		$	6
Other assets, net		218			132
Accrued liabilities		(13	)		(4	)

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-SubTopic 10
-Topic 360
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482099/360-10-50-3

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Section 45
-Paragraph 11
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483475/205-20-45-11

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org//1943274/2147483499/205-20-50-3A

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org//1943274/2147483499/205-20-50-4A

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Section 50
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-URI https://asc.fasb.org//1943274/2147483499/205-20-50-4B

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-Section 50
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-URI https://asc.fasb.org//1943274/2147483499/205-20-50-5A

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-Name Accounting Standards Codification
-Section 50
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-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483499/205-20-50-3

+ Details

Comprehensive Loss - Schedule of Changes in Accumulated Other Comprehensive Income (Loss) ("AOCL") by Component (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accumulated Other Comprehensive Income Loss [Line Items]
AOCL, Beginning Balance	$ (21)	$ (14)
Other comprehensive (loss) income before reclassifications	7	(6)
Amounts reclassified from AOCL		(1)
Other comprehensive income (loss)	7	(7)	$ (2)
AOCL, Ending Balance	(14)	(21)	(14)
Change in Fair Value of Available for Sale Debt Securities
Accumulated Other Comprehensive Income Loss [Line Items]
AOCL, Beginning Balance	(19)	(2)
Other comprehensive (loss) income before reclassifications	6	(16)
Amounts reclassified from AOCL		(1)
Other comprehensive income (loss)	6	(17)
AOCL, Ending Balance	(13)	(19)	(2)
Change in Unrecognized Pension Cost Components
Accumulated Other Comprehensive Income Loss [Line Items]
AOCL, Beginning Balance	(2)	(12)
Other comprehensive (loss) income before reclassifications	1	10
Other comprehensive income (loss)	1	10
AOCL, Ending Balance	$ (1)	$ (2)	$ (12)

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

Amount, after tax, of accumulated increase (decrease) in equity from transaction and other event and circumstance from nonowner source.

+ References + Details

- Definition

Amount after tax and reclassification adjustments of other comprehensive income (loss).

+ References

+ Details

Income Taxes - Schedule of Reconciliation between the Statutory Federal Income Tax Rate and the Effective Tax Rate (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Differences between the statutory federal income tax rate and the effective tax rate
Provision for income taxes at statutory federal rate, Amount	$ 44	$ 73	$ 105
State income taxes, net of federal income tax benefit, Amount	37	3	44
Net income attributable to noncontrolling interests, Amount	(31)	(28)	(29)
Change in valuation allowance, Amount	88	122	33
Change in uncertain tax position, Amount	10
Nondeductible goodwill, Amount	29
Amended return adjustments, Amount	9		(22)
Other, Amount	5
Total provision for income taxes for income	$ 191	$ 170	$ 131
Provision for income taxes at statutory federal rate, Percentage	21.00%	21.00%	21.00%
State income taxes, net of federal income tax benefit, Percentage	17.90%	0.80%	8.70%
Net income attributable to noncontrolling interests, Percentage	(14.90%)	(8.00%)	(5.80%)
Change in valuation allowance, Percentage	42.50%	34.90%	6.80%
Change in uncertain tax position, Percent	4.90%
Nondeductible goodwill, Percentage	14.10%
Amended return adjustments, Percentage	4.30%		(4.40%)
Other, Percentage	2.50%
Provision for income taxes and effective tax rate for income, Percentage	92.30%	48.70%	26.30%

Leases - Supplemental Cash Flow and Other Information Related to Leases (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases	$ 200	$ 204	$ 197
Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from finance leases	13	15	9
Cash paid for amounts included in the measurement of lease liabilities: Financing cash flows from finance leases	3	9	4
ROU assets obtained in exchange for new finance lease liabilities	1	42	166
ROU assets obtained in exchange for new operating lease liabilities	$ 102	$ 195	$ 143
Weighted-average remaining lease term: Operating leases	9 years	8 years	6 years
Weighted-average remaining lease term: Finance leases	30 years	31 years	30 years
Weighted-average discount rate: Operating leases	8.80%	8.00%	8.10%
Weighted-average discount rate: Finance leases	6.20%	6.40%	6.30%

Goodwill and Other Intangible Assets - Goodwill - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	$ 3,958,000,000	$ 4,166,000,000	$ 4,219,000,000
Impairment of goodwill	$ 0	$ 0	$ 0

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

LEASES

9. LEASES

The Company utilizes operating and finance leases for the use of certain hospitals, medical office buildings, and medical equipment. All lease agreements generally require the Company to pay maintenance, repairs, property taxes and insurance costs, which are variable amounts based on actual costs incurred during each applicable period. Such costs are not included in the determination of the ROU asset or lease liability. Variable lease cost also includes escalating rent payments that are not fixed at commencement but are based on an index that is determined in future periods over the lease term based on changes in the Consumer Price Index or other measures of cost inflation. Most leases include one or more options to renew the lease at the end of the initial term, with renewal terms that generally extend the lease at the then market rate of rental payment. Certain leases also include an option to buy the underlying asset at or a short time prior to the termination of the lease. All such options are at the Company’s discretion and are evaluated at the commencement of the lease, with only those that are reasonably certain of exercise included in determining the appropriate lease term.

The components of lease cost and rent expense for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):


	Year Ended December 31,
Lease Cost	2023			2022			2021
Operating lease cost:
Operating lease cost	$	211		$	211		$	196
Short-term rent expense		90			87			92
Variable lease cost		23			24			25
Sublease income		(5	)		(5	)		(5	)
Total operating lease cost	$	319		$	317		$	308
Finance lease cost:
Amortization of ROU assets	$	13		$	13		$	9
Interest on finance lease liabilities		13			15			9
Total finance lease cost	$	26		$	28		$	18

Supplemental balance sheet information related to leases was as follows (in millions):


	Balance Sheet Classification	December 31, 2023			December 31, 2022
Operating Leases:
Operating Lease ROU Assets	Other assets, net	$	665		$	738

Finance Leases:
Finance Lease ROU Assets	Property and equipment
	Land and improvements	$	—		$	—
	Buildings and improvements		246			261
	Equipment and fixtures		10			12
	Property and equipment		256			273
	Less accumulated depreciation and amortization		(55	)		(56	)
	Property and equipment, net	$	201		$	217

Current finance lease liabilities	Current maturities of long-term debt	$	2		$	3
Long-term finance lease liabilities	Long-term debt		214			220

Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):


	Year Ended December 31,
Cash flow information	2023			2022			2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases (1)	$	200		$	204		$	197
Operating cash flows from finance leases		13			15			9
Financing cash flows from finance leases		3			9			4
ROU assets obtained in exchange for new finance lease liabilities		1			42			166
ROU assets obtained in exchange for new operating lease liabilities		102			195			143
Weighted-average remaining lease term:
Operating leases	9 years			8 years			6 years
Finance leases	30 years			31 years			30 years
Weighted-average discount rate:
Operating leases		8.8	%		8.0	%		8.1	%
Finance leases		6.2	%		6.4	%		6.3	%

(1)

Included in the change in other operating assets and liabilities in the consolidated statements of cash flows.

Commitments relating to noncancellable operating and finance leases and financing obligations for each of the next five years and thereafter are as follows (in millions):


							Financing
Year Ending December 31,	Operating			Finance			Obligations
2024	$	181		$	16		$	13
2025		144			15			13
2026		118			16			13
2027		92			16			13
2028		75			16			14
Thereafter		467			472			59
Total minimum future payments		1,077			551			125
Less: Imputed interest		(390	)		(335	)		26
Total liabilities		687			216			151
Less: Current portion		(124	)		(2	)		(3	)
Long-term liabilities	$	563		$	214		$	148

As of December 31, 2023, there were approximately $36 million of assets underlying approved but pending leases that have not yet commenced, primarily for leases of various real-estate and medical equipment.

Goodwill and Other Intangible Assets - Schedule of Goodwill (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill	$ 6,772	$ 6,980	$ 7,033
Accumulated impairment losses	(2,814)	(2,814)	(2,814)
Goodwill	3,958	4,166	$ 4,219
Goodwill acquired as part of acquisitions during current year	23	11
Goodwill allocated to hospitals divested or held-for-sale	$ (231)	$ (64)

- Definition

+ References + Details

Stockholders' Deficit (Tables)

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Schedule of Impact of Noncontrolling Interest to Stockholders' Deficit


	Year Ended December 31,
	2023			2022			2021
Net (loss) income attributable to Community Health Systems,
Inc. stockholders	$	(133	)	$	46		$	230
Transfers to the noncontrolling interests:
Net increase (decrease) in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests		5			(6	)		17
Net transfers to the noncontrolling interests		5			(6	)		17
Change to Community Health Systems, Inc. stockholders’ deficit from net (loss) income attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$	(128	)	$	40		$	247

Income Taxes - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Taxes [Line Items]
Effective income tax rate	92.30%	48.70%	26.30%
Operating loss carryforwards, valuation allowance	$ 983
Unrecognized benefit that would affect the effective tax rate	45
Amount of interest and penalties included in liabilities for uncertain tax positions	2
Income tax refunds (payments), net	$ (91)	$ (6)	$ (4)
Minimum
Income Taxes [Line Items]
Operating loss carryforwards, expiration date	Jan. 01, 2024
Maximum
Income Taxes [Line Items]
Operating loss carryforwards, expiration date	Dec. 31, 2043
Federal
Income Taxes [Line Items]
Net operating loss and credit carryforwards	$ 9,900
Valuation allowance increase (decrease)	$ 88	122
Federal \| Tax Year 2014, 2015 and 2018
Income Taxes [Line Items]
Open tax year	2014 2015 2018
Federal \| Maximum
Income Taxes [Line Items]
Operating loss carryforwards expected to be utilized	$ 1
State and Local Jurisdiction
Income Taxes [Line Items]
Operating loss carryforwards expected to be utilized	533
Valuation allowance increase (decrease)	$ 66	$ (108)

Long-Term Debt - 6.25% Senior Secured Notes, Due 2023 - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Extinguishment of debt amount	$ 402	$ 645
Issuance of long-term debt	$ 989	$ 1,535	$ 4,310

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Fair Value (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets Measured on Recurring Basis

The following table sets forth, by level within the fair value hierarchy, the financial assets recorded at fair value on a recurring basis as of December 31, 2023 and 2022 (in millions):


	December 31, 2023		Level 1		Level 2		Level 3
Investments in equity securities	$	69	$	69	$	—	$	—
Available-for-sale debt securities		182		—		182		—
Trading securities		5		—		5		—
Total assets	$	256	$	69	$	187	$	—


	December 31, 2022		Level 1		Level 2		Level 3
Investments in equity securities	$	107	$	107	$	—	$	—
Available-for-sale debt securities		179		—		179		—
Trading securities		5		—		5		—
Total assets	$	291	$	107	$	184	$	—

Supplemental Information Regarding Available-for-Sale Debt Securities

Supplemental information regarding the Company’s available-for-sale debt securities (all of which had no withdrawal restrictions) is set forth in the table below (in millions):


			Gross		Gross			Estimated
	Amortized		Unrealized		Unrealized			Fair
	Cost		Gains		Losses			Values
As of December 31, 2023:
Government	$	118	$	—	$	(10	)	$	108
Corporate		65		—		(6	)		59
Mortgage and asset-backed securities		16		—		(1	)		15
Total available-for-sale debt securities	$	199	$	—	$	(17	)	$	182


			Gross		Gross			Estimated
	Amortized		Unrealized		Unrealized			Fair
	Cost		Gains		Losses			Values
As of December 31, 2022:
Government	$	107	$	—	$	(11	)	$	96
Corporate		69		—		(9	)		60
Mortgage and asset-backed securities		25		—		(2	)		23
Total available-for-sale debt securities	$	201	$	—	$	(22	)	$	179

Contractual Maturities of Debt Securities


	December 31, 2023				December 31, 2022
	Amortized		Estimated		Amortized		Estimated
	Cost		Fair Values		Cost		Fair Values
Within 1 year	$	19	$	19	$	13	$	13
After 1 year and through year 5		63		62		74		70
After 5 years and through year 10		63		57		56		48
After 10 years		54		44		58		48

Gross Realized Gains and Losses and Investment Income on Available-for-Sale Debt Securities

Gross realized gains and losses on sales of available-for-sale debt securities are summarized in the table below (in millions):


	Year Ended December 31,
	2023			2022			2021
Realized gains	$	—		$	—		$	1
Realized losses		(2	)		(2	)		(1	)

Net Losses and Gains Recognized for Investments in Equity Securities


	Year Ended December 31,
	2023			2022			2021
Net gains and (losses) recognized during the year on equity securities	$	11		$	(28	)	$	20
Less: Net (losses) and gains recognized during the year on equity securities sold during the year		(5	)		(2	)		13
Unrealized gains and (losses) recognized during the year on equity securities held at the end of year	$	16		$	(26	)	$	7

Fair Value - Contractual Maturities of Debt Securities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Within 1 year, Amortized Cost	$ 19	$ 13
After 1 year and through year 5, Amortized Cost	63	74
After 5 years and through year 10, Amortized Cost	63	56
After 10 years, Amortized Cost	54	58
Within 1 year, Fair Value	19	13
After 1 year and through year 5, Fair Value	62	70
After 5 years and through year 10, Fair Value	57	48
After 10 years, Fair Value	$ 44	$ 48

Long-Term Debt - 8% Senior Secured Notes, Due 2027 - Additional Information (Details) - Senior Secured Notes - Senior Secured Notes at 8% Due 2027 - USD ($)		12 Months Ended
	Nov. 19, 2019	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt instrument aggregate principal amount	$ 700,000,000
Debt instrument stated interest rate	8.00%	8.00%	8.00%
Minimum period notice for redemption of debt	15 days
Maximum period notice for redemption of debt	60 days
Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt instrument redemption price percentage		100.00%
Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt instrument redemption price percentage		102.00%

Long-Term Debt - Schedule of Early Redemption Prices on 6.875% Senior Notes Due 2028 (Details) - Senior Notes At 6.875% Due 2028 - Senior Notes	12 Months Ended
	Dec. 31, 2023
Debt Instrument, Redemption, Period Three
Debt Instrument Redemption Price Percentage	103.438%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2023
Debt Instrument, Redemption Period, End Date	Mar. 31, 2024
Debt Instrument, Redemption, Period Four
Debt Instrument Redemption Price Percentage	101.719%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2024
Debt Instrument, Redemption Period, End Date	Mar. 31, 2025
Debt Instrument, Redemption, Period Five
Debt Instrument Redemption Price Percentage	100.00%
Debt Instrument, Redemption Period, Start Date	Apr. 01, 2025
Debt Instrument, Redemption Period, End Date	Mar. 31, 2028

Earnings Per Share - Schedule of Components of Denominator for Computation of Basic and Diluted (Loss) Earnings Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Effect of dilutive securities:
Weighted-average number of shares outstanding — basic	130,445,677	128,808,387	126,754,852
Restricted stock awards		842,055	2,803,938
Employee stock options		278,057	726,130
Other equity-based awards		131,820	312,490
Weighted-average number of shares outstanding — diluted	130,445,677	130,060,319	130,597,410

Acquisitions, Divestitures and Closures - Divestitures - Additional Information (Details)	Dec. 31, 2023 Item
Greenbrier Valley Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	122
Plateau Medical Center
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	25

Long-Term Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Instrument [Line Items]

Schedule of Debt

Long-term debt, net of unamortized debt issuance costs and discounts or premiums, consists of the following (in millions):


	December 31,
	2023			2022
8% Senior Secured Notes due 2026	$	1,116		$	2,101
8% Senior Secured Notes due 2027		700			700
5⅝% Senior Secured Notes due 2027		1,900			1,900
6⅞% Senior Notes due 2028		756			756
6% Senior Secured Notes due 2029		644			900
5¼% Senior Secured Notes due 2030		1,535			1,535
4¾% Senior Secured Notes due 2031		1,058			1,058
10⅞% Senior Secured Notes due 2032		1,000			—
6⅞% Junior-Priority Secured Notes due 2029		1,244			1,386
6⅛% Junior-Priority Secured Notes due 2030		1,227			1,232
ABL Facility		247			53
Finance lease and financing obligations		366			380
Other		32			36
Less: Unamortized deferred debt issuance costs and note discount		(338	)		(402	)
Total debt		11,487			11,635
Less: Current maturities		(21	)		(21	)
Total long-term debt	$	11,466		$	11,614

Summary of Extinguished Portion of Certain Series of Outstanding Notes


	December 31,
	2023		2022
6⅞% Senior Notes due 2028	$	—	$	11
6% Senior Secured Notes due 2029		256		—
4¾% Senior Secured Notes due 2031		—		37
6⅞% Junior-Priority Secured Notes due 2029		142		389
6⅛% Junior-Priority Secured Notes due 2030		4		208
Total principal amount of debt extinguished	$	402	$	645

Schedule of Maturities of Long-term Debt


Year Ending December 31,	Amount
2024	$	21
2025		12
2026		1,372
2027		2,609
2028		765
Thereafter		7,045
Total maturities		11,824
Less: Deferred debt issuance costs		(322	)
Less: Unamortized note discount		(15	)
Total long-term debt	$	11,487

Senior Secured Notes at 8%, Due 2026 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
March 15, 2023 to March 14, 2024		102.000	%
March 15, 2024 to March 14, 2026		100.000	%

Senior Secured Notes at 8% Due 2027 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
December 15, 2023 to December 14, 2024		102.000	%
December 15, 2024 to December 14, 2027		100.000	%

5⅝% Senior Secured Notes due 2027 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
December 15, 2023 to December 14, 2024		102.813	%
December 15, 2024 to December 14, 2025		101.406	%
December 15, 2025 to December 14, 2027		100.000	%

Senior Notes at 6.875% Due 2028 | Senior Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
April 1, 2023 to March 31, 2024		103.438	%
April 1, 2024 to March 31, 2025		101.719	%
April 1, 2025 to March 31, 2028		100.000	%

6% Senior Secured Notes due 2029 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
January 15, 2024 to January 14, 2025		103.000	%
January 15, 2025 to January 14, 2026		101.500	%
January 15, 2026 to January14, 2029		100.000	%

Senior Secured Notes 5.250%, Due 2030 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
May 15, 2025 to May 14, 2026		102.625	%
May 15, 2026 to May 14, 2027		101.313	%
May 15, 2027 to May 14, 2030		100.000	%

Senior Secured Notes at 4.75% due 2031 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
February 15, 2026 to February 14, 2027		102.375	%
February 15, 2027 to February 14, 2028		101.583	%
February 15, 2028 to February 14, 2029		100.792	%
February 15, 2029 to February 14, 2031		100.000	%

Junior-Priority Secured Notes at 6.875% Due 2029 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
April 15, 2024 to April 14, 2025		103.438	%
April 15, 2025 to April 14, 2026		101.719	%
April 15, 2026 to April 14, 2029		100.000	%

Junior-Priority Secured Notes at 6.125% Due 2030 | Senior Secured Notes

Debt Instrument [Line Items]

Schedule of Early Redemption Prices on Notes


Period	Redemption Price
April 1, 2025 to March 31, 2026		103.063	%
April 1, 2026 to March 31, 2027		101.531	%
April 1, 2027 to March 31, 2030		100.000	%

Accounting for Stock-Based Compensation - Additional Information (Details)				12 Months Ended
	Mar. 01, 2023 USD ($) Director shares	Mar. 01, 2022 USD ($) Director shares	Mar. 01, 2021 USD ($) Director shares	Dec. 31, 2023 USD ($) Item $ / shares shares	Dec. 31, 2022 USD ($) Item $ / shares shares	Dec. 31, 2021 USD ($) Item $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee service share-based compensation, unrecognized compensation costs on nonvested awards				$ 27,000,000
Employee service share-based compensation total compensation cost not yet recognized, period for recognition				20 months
Employee service share-based compensation, nonvested awards, modifications to awards \| Item				0	0	0
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value of options exercised				$ 1,000,000	$ 1,000,000	$ 1,000,000
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee service share-based compensation total compensation cost not yet recognized, period for recognition				20 months
Employee service share-based compensation, unrecognized compensation costs on nonvested stock options				$ 5,000,000
Weighted-average grant date fair value of stock options \| $ / shares				$ 4.61	$ 7.25	$ 6.22
Share Price \| $ / shares				$ 3.13
Restricted Stock and RSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee service share-based compensation total compensation cost not yet recognized, period for recognition				20 months
Employee service share-based compensation, unrecognized compensation costs on nonvested awards other than options				$ 22,000,000
Restricted Stock, Performance-Based Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by payment award, performance objective measurement period				3 years
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, number of grants \| shares				365,037	176,820	173,664
Number of directors elected to defer the receipt of RSUs granted \| Director	4	3	4
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement award vesting rights				one-third increments on each of the first three anniversaries of the award date
Share-based compensation, number of grants \| shares				2,746,000	3,253,000	2,929,250
Plan 2009
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement award vesting rights				one-third increments on each of the first three anniversaries of the option grant date
Contractual term of option granted				10 years
Unissued common stock reserved for grants \| shares				9,017,113
Plan 2009 \| Restricted Stock Units (RSUs) \| Non-management Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, number of grants \| shares	29,268	17,682	19,296
Fair value of units granted	$ 180,000	$ 180,000	$ 170,000
Plan 2009 \| Restricted Stock Units (RSUs) \| Board Of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, number of grants \| shares	43,089
Fair value of units granted	$ 265,000
Performance-Based Awards Granted On March 1, 2018 \| Restricted Stock, Performance-Based Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement award vesting rights, percentage	100.00%