0000950170-24-117088 | 10-Q | XBRL Viewer | Community Health Systems INC

Fair Value of Financial Instruments

9 Months Ended

Sep. 30, 2024

7. FAIR VALUE OF FINANCIAL INSTRUMENTS

The fair value of financial instruments has been estimated by the Company using available market information as of September 30, 2024 and December 31, 2023, 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):


	September 30, 2024				December 31, 2023
	Carrying		Estimated Fair		Carrying		Estimated Fair
	Amount		Value		Amount		Value
Assets:
Cash and cash equivalents	$	33	$	33	$	38	$	38
Investments in equity securities		66		66		69		69
Available-for-sale debt securities		195		195		182		182
Trading securities		5		5		5		5
Liabilities:
8% Senior Secured Notes due 2026		—		—		1,109		1,114
8% Senior Secured Notes due 2027		695		703		695		679
5⅝% Senior Secured Notes due 2027		1,719		1,729		1,847		1,767
6⅞% Senior Notes due 2028		622		529		750		470
6% Senior Secured Notes due 2029		625		625		622		580
5¼% Senior Secured Notes due 2030		1,465		1,416		1,458		1,287
4¾% Senior Secured Notes due 2031		1,054		931		1,054		834
10⅞% Senior Secured Notes due 2032		2,212		2,452		982		1,047
6⅞% Junior-Priority Secured Notes due 2029		1,172		1,128		1,162		812
6⅛% Junior-Priority Secured Notes due 2030		1,173		1,045		1,167		781
ABL Facility and other debt		391		391		275		275

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.

- 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.

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+ Details

Accounting for Stock-Based Compensation (Tables)

9 Months Ended

Sep. 30, 2024

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):


	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2024			2023			2024			2023
Effect on income before income taxes	$	(5	)	$	(6	)	$	(12	)	$	(16	)
Effect on net loss	$	(4	)	$	(5	)	$	(10	)	$	(13	)

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

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 three and nine months ended September 30, 2024 and 2023:


	Three Months Ended September 30,		Nine Months Ended September 30,
	2024	2023	2024	2023
Expected volatility	N/A	N/A	90.1%	87.3%
Expected dividends	N/A	N/A	—	—
Expected term	N/A	N/A	6 years	6 years
Risk-free interest rate	N/A	N/A	4.3%	4.2%

Schedule of Share-based Compensation, Stock Options, Activity

Options outstanding and exercisable under the 2009 Plan as of September 30, 2024, and changes during each of the three-month periods following December 31, 2023, was as follows (in millions, except share and per share data):


						Weighted-	Aggregate
				Weighted-		Average	Intrinsic
				Average		Remaining	Value as of
				Exercise		Contractual	September 30,
	Shares			Price		Term	2024
Outstanding at December 31, 2023		3,630,750		$	7.07
Granted		901,000			2.87
Exercised		—			—
Forfeited and cancelled		(27,000	)		4.96
Outstanding at March 31, 2024		4,504,750			6.24
Granted		—			—
Exercised		—			—
Forfeited and cancelled		(14,000	)		4.99
Outstanding at June 30, 2024		4,490,750			6.24
Granted		—			—
Exercised		—			—
Forfeited and cancelled		—			—
Outstanding at September 30, 2024		4,490,750		$	6.24	7 years	$	4
Exercisable at September 30, 2024		2,793,739		$	6.99	6 years	$	1

Schedule of Share-based Compensation, Restricted Stock, Activity

Restricted stock outstanding under the 2009 Plan as of September 30, 2024, and changes during each of the three-month periods following December 31, 2023, was as follows:


				Weighted-
				Average Grant
	Shares			Date Fair Value
Unvested at December 31, 2023		6,053,823		$	8.00
Granted		2,842,000			2.87
Vested		(2,111,567	)		8.47
Forfeited		(147,001	)		8.34
Unvested at March 31, 2024		6,637,255			5.65
Granted		4,000			3.78
Vested		(44,335	)		6.63
Forfeited		(5,334	)		5.22
Unvested at June 30, 2024		6,591,586			6.64
Granted		—			—
Vested		(18,336	)		7.69
Forfeited		(19,335	)		4.67
Unvested at September 30, 2024		6,553,915			5.64

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

RSUs outstanding under the 2009 Plan as of September 30, 2024, and changes during each of the three-month periods following December 31, 2023, was as follows:


				Weighted-
				Average Grant
	Shares			Date Fair Value
Unvested at December 31, 2023		775,926		$	6.86
Granted		844,950			2.87
Vested		(129,384	)		7.78
Forfeited		—			—
Unvested at March 31, 2024		1,491,492			4.52
Granted		62,718			3.96
Vested		(5,894	)		5.00
Forfeited		—			—
Unvested at June 30, 2024		1,548,316			4.49
Granted		—			—
Vested		—			—
Forfeited		—			—
Unvested at September 30, 2024		1,548,316			4.49

Fair Value - Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investments in equity securities	$ 66	$ 69
Available-for-sale debt securities	195	182
Trading securities	5	5
Total assets	266	256
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investments in equity securities	66	69
Total assets	66	69
Fair Value, Inputs, Level 2
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale debt securities	195	182
Trading securities	5	5
Total assets	$ 200	$ 187

- Definition

Amount of investment in debt security measured at fair value with change in fair value recognized in other comprehensive income (available-for-sale).

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+ Details

Stockholders' Deficit - Schedule of Impact of Noncontrolling Interest to Stockholders' Deficit (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Equity [Abstract]
Net loss attributable to Community Health Systems, Inc. stockholders	$ (391)	$ (91)	$ (446)	$ (180)
Net increase in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests	1		4	5
Net transfers to the noncontrolling interests	1		4	5
Change to Community Health Systems, Inc. stockholders' deficit from net loss attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$ (390)	$ (91)	$ (442)	$ (175)

- 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 29: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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Reference 31: http://www.xbrl.org/2003/role/disclosureRef
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Reference 32: http://www.xbrl.org/2003/role/disclosureRef
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Reference 33: http://www.xbrl.org/2003/role/disclosureRef
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Reference 35: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1A

Reference 36: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1B
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1B

Reference 37: http://fasb.org/us-gaap/role/ref/legacyRef
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-Paragraph 1
-Subparagraph (SX 210.9-04(22))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

+ Details

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities:
Net loss	$ (334)	$ (70)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	357	384
Deferred income taxes	(129)	22
Stock-based compensation expense	12	16
Impairment and (gain) loss on sale of businesses, net	294	(9)
Gain from early extinguishment of debt	(25)
Other non-cash expenses, net	142	132
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:
Patient accounts receivable	126	(119)
Supplies, prepaid expenses and other current assets	(48)	(100)
Accounts payable, accrued liabilities and income taxes	(119)	(69)
Other	(12)	(67)
Net cash provided by operating activities	264	120
Cash flows from investing activities:
Acquisitions of facilities and other related businesses	(1)	(35)
Purchases of property and equipment	(251)	(357)
Proceeds from disposition of hospitals and other ancillary operations	174	123
Proceeds from sale of property and equipment	5	27
Purchases of available-for-sale debt securities and equity securities	(54)	(126)
Proceeds from sales of available-for-sale debt securities and equity securities	54	221
Purchases of investments in unconsolidated affiliates	(4)	(8)
Increase in other investments	(55)	(51)
Net cash used in investing activities	(132)	(206)
Cash flows from financing activities:
Repurchase of restricted stock shares for payroll tax withholding requirements	(2)	(4)
Deferred financing costs and other debt-related costs	(8)
Proceeds from noncontrolling investors in joint ventures	1	4
Redemption of noncontrolling investments in joint ventures	(3)	(1)
Distributions to noncontrolling investors in joint ventures	(121)	(108)
Other borrowings	18	30
Issuance of long-term debt	1,236
Proceeds from ABL Facility	2,662	2,290
Repayments of long-term indebtedness	(3,920)	(2,152)
Net cash (used in) provided by financing activities	(137)	59
Net change in cash and cash equivalents	(5)	(27)
Cash and cash equivalents at beginning of period	38	118
Cash and cash equivalents at end of period	33	91
Supplemental disclosure of cash flow information:
Interest payments	(562)	(583)
Income tax payments, net	$ (132)	$ (61)

Subsequent Events

9 Months Ended

Sep. 30, 2024

Subsequent Events [Abstract]

Subsequent Events

13. SUBSEQUENT EVENTS

The Company has evaluated all material events occurring subsequent to the balance sheet date for events requiring disclosure or recognition in the condensed consolidated financial statements.

On October 1, 2024, the Company completed the sale of substantially all of the assets of Davis Regional Medical Center (144 licensed beds) in Statesville, North Carolina, to Iredell Memorial Hospital, Inc. pursuant to a definitive agreement which was entered into on August 16, 2024. The net proceeds from this sale of approximately $13 million were received at a preliminary closing on September 30, 2024.

Leases - Components of Lease Cost and Rent Expense (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Leases [Abstract]
Operating lease cost	$ 46	$ 52	$ 140	$ 160
Short-term rent expense	21	22	67	66
Variable lease cost	7	6	20	18
Sublease income	(1)	(1)	(3)	(4)
Total operating lease cost	73	79	224	240
Finance lease cost:
Amortization of right-of-use assets	2	4	7	10
Interest on finance lease liabilities	3	3	10	10
Total finance lease cost	$ 5	$ 7	$ 17	$ 20

Basis of Presentation and Significant Accounting Policies - Additional Information (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($) Hospital	Dec. 31, 2023 USD ($)	Dec. 31, 2022
Cost of Revenue, Policy [Abstract]
Corporate Office Costs	$ 72	$ 61	$ 228	$ 187
Third Party Reimbursement [Abstract]
Amounts due to third party payors	138		138		$ 97
Amounts due from third party payors	146		146		$ 130
Net Operating Revenues, Policy [Abstract]
Charity care services charges excluded from net operating revenues	304	355	906	1,000
Value of charity care services at the Company's standard charges included in contractual allowances	$ 31	$ 39	89	$ 111
Accounting for the Impairment or Disposal of Long-Lived Assets
Net expense			294
Number of hospitals sold \| Hospital				3
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]						true
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]						true
Hospitals Sold or Deemed Held for Sale
Accounting for the Impairment or Disposal of Long-Lived Assets
Gain (loss) on disposition of business			4	$ 9
Amount related to several assets idled disposed or held for sale			39	8
Adjustment for Carrying Value of Other Long-Lived Assets at Underperforming Hospitals
Accounting for the Impairment or Disposal of Long-Lived Assets
Amount related to several assets idled disposed or held for sale			259	25
Impairment of long-lived assets held for sale				21
Shared Service Center
Accounting for the Impairment or Disposal of Long-Lived Assets
Gain (loss) on disposition of business			$ 127	$ 84

Contingencies - Schedule of Reconciliation of the Beginning and Ending Liability Balances in Connection with Probable Contingencies (Details) - Pending Litigation [Member] - Other Probable Contingencies [Member] $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($)
Loss Contingency Accrual [Roll Forward]
Beginning Balance	$ 7
Expense	2
Reserve for insured claim	9
Cash payments	(2)
Ending Balance	$ 16

Stockholders' Deficit

9 Months Ended

Sep. 30, 2024

Equity [Abstract]

STOCKHOLDERS' DEFICIT

10. 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 September 30, 2024, 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 September 30, 2024, 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 schedule below presents the reconciliation of the carrying amount of total equity, equity attributable to the Company’s stockholders, and equity attributable to noncontrolling interests as of September 30, 2024, and during each of the three-month periods following December 31, 2023 (in millions).


				Community Health Systems, Inc. Stockholders
	Redeemable Noncontrolling Interest			Common Stock		Additional Paid-In Capital			Accumulated Other Comprehensive (Loss) Income			Accumulated Deficit			Noncontrolling Interest			Total Stockholders’ Deficit
Balance, December 31, 2023	$	323		$	1	$	2,185		$	(14	)	$	(3,564	)	$	245		$	(1,147	)
Comprehensive income (loss)		16			—		—			(2	)		(41	)		19			(24	)
Distributions to noncontrolling interests		(17	)		—		—			—			—			(33	)		(33	)
Adjustment to redemption value of redeemable noncontrolling interests		(3	)		—		3			—			—			—			3
Cancellation of restricted stock for tax withholdings on vested shares		—			—		(2	)		—			—			—			(2	)
Other reclassifications of noncontrolling interests		10			—		—			—			—			(10	)		(10	)
Share-based compensation		—			—		6			—			—			—			6
Balance, March 31, 2024		329			1		2,192			(16	)		(3,605	)		221			(1,207	)
Comprehensive income (loss)		15			—		—			3			(14	)		25			14
Distributions to noncontrolling interests		(14	)		—		—			—			—			(20	)		(20	)
Purchases of subsidiary shares from noncontrolling interests		1			—		(2	)		—			—			—			(2	)
Adjustment to redemption value of redeemable noncontrolling interests		2			—		(2	)		—			—			—			(2	)
Other reclassifications of noncontrolling interests		(9	)		—		—			—			—			12			12
Share-based compensation		—			—		2			—			—			—			2
Balance, June 30, 2024		324			1		2,190			(13	)		(3,619	)		238			(1,203	)
Comprehensive income (loss)		13			—		—			5			(391	)		23			(363	)
Distributions to noncontrolling interests		(10	)		—		—			—			—			(26	)		(26	)
Purchases of subsidiary shares from noncontrolling interests		—			—		(1	)		—			—			—			(1	)
Adjustment to redemption value of redeemable noncontrolling interests		(1	)		—		1			—			—			—			1
Disposition of less-than-wholly owned entity		(4	)		—		—			—			—			(4	)		(4	)
Share-based compensation		—			—		4			—			—			—			4
Balance, September 30, 2024	$	322		$	1	$	2,194		$	(8	)	$	(4,010	)	$	231		$	(1,592	)

The following schedule presents the reconciliation of the carrying amount of total equity, equity attributable to the Company’s stockholders, and equity attributable to the noncontrolling interests as of September 30, 2023, and during each of the three-month periods following December 31, 2022 (in millions):


				Community Health Systems, Inc. Stockholders
	Redeemable Noncontrolling Interest			Common Stock		Additional Paid-In Capital			Accumulated Other Comprehensive (Loss) Income			Accumulated Deficit			Noncontrolling Interest			Total Stockholders’ Deficit
Balance, December 31, 2022	$	541		$	1	$	2,084		$	(21	)	$	(3,431	)	$	92		$	(1,275	)
Comprehensive income (loss)		21			—		—			3			(51	)		11			(37	)
Distributions to noncontrolling interests		(33	)		—		—			—			—			(11	)		(11	)
Purchases of subsidiary shares from noncontrolling interests		(1	)		—		—			—			—			—			—
Contributions from noncontrolling interests		1			—		—			—			—			1			1
Adjustment to redemption value of redeemable noncontrolling interests		32			—		(32	)		—			—			—			(32	)
Cancellation of restricted stock for tax withholdings on vested shares		—			—		(4	)		—			—			—			(4	)
Share-based compensation		—			—		6			—			—			—			6
Balance, March 31, 2023		561			1		2,054			(18	)		(3,482	)		93			(1,352	)
Comprehensive income (loss)		28			—		—			(1	)		(38	)		11			(28	)
Distributions to noncontrolling interests		(21	)		—		—			—			—			(19	)		(19	)
Contributions from noncontrolling interests		—			—		—			—			—			1			1
Purchases of subsidiary shares from noncontrolling interests		(6	)		—		5			—			—			—			5
Noncontrolling interest in acquired entity		7			—		—			—			—			—			—
Adjustment to redemption value of redeemable noncontrolling interests		14			—		(14	)		—			—			—			(14	)
Share-based compensation		—			—		4			—			—			—			4
Balance, June 30, 2023		583			1		2,049			(19	)		(3,520	)		86			(1,403	)
Comprehensive income (loss)		12			—		—			(3	)		(91	)		27			(67	)
Distributions to noncontrolling interests		(8	)		—		—			—			—			(17	)		(17	)
Other reclassifications of noncontrolling interests		(265	)		—		122			(1	)		—			145			266
Adjustment to redemption value of redeemable noncontrolling interests		7			—		(7	)		—			—			—			(7	)
Share-based compensation		—			—		6			—			—			—			6
Balance, September 30, 2023	$	329		$	1	$	2,170		$	(23	)	$	(3,611	)	$	241		$	(1,222	)


	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2024			2023			2024			2023
Net loss attributable to Community Health Systems, Inc. stockholders	$	(391	)	$	(91	)	$	(446	)	$	(180	)
Transfers to the noncontrolling interests:
Net increase in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests		1			—			4			5
Net transfers to the noncontrolling interests		1			—			4			5
Change to Community Health Systems, Inc. stockholders’ deficit from net loss attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$	(390	)	$	(91	)	$	(442	)	$	(175	)

- 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
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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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 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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+ Details

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Restricted Stock Units, Activity (Details) - Restricted Stock Units (RSUs) - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Unvested Shares	1,548,316	1,491,492	775,926
Granted, Shares		62,718	844,950
Vested, Shares		(5,894)	(129,384)
Ending Balance, Unvested Shares	1,548,316	1,548,316	1,491,492
Beginning of Period, Weighted Average Grant Date Fair Value	$ 4.49	$ 4.52	$ 6.86
Granted, Weighted Average Grant Date Fair Value		3.96	2.87
Vested, Weighted Average Grant Date Fair Value		5	7.78
End of Period, Weighted Average Grant Date Fair Value	$ 4.49	$ 4.49	$ 4.52

- 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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+ Details

Subsequent Events - Additional Information (Details) - Davis Regional Medical Center - Statesville, North Carolina $ in Millions	Sep. 30, 2024 USD ($)	Oct. 01, 2024 Item	Aug. 16, 2024 Item
Subsequent Event [Line Items]
Number of licensed beds			144
Proceeds from sale of afiliates assets \| $	$ 13
Subsequent Event [Member]
Subsequent Event [Line Items]
Number of licensed beds		144

Long-Term Debt

9 Months Ended

Sep. 30, 2024

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, as applicable, consists of the following (in millions):


	September 30,			December 31,
	2024			2023
8% Senior Secured Notes due 2026	$	—		$	1,116
8% Senior Secured Notes due 2027		700			700
5⅝% Senior Secured Notes due 2027		1,757			1,900
6⅞% Senior Notes due 2028		626			756
6% Senior Secured Notes due 2029		644			644
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		2,225			1,000
6⅞% Junior-Priority Secured Notes due 2029		1,244			1,244
6⅛% Junior-Priority Secured Notes due 2030		1,227			1,227
ABL Facility		372			247
Finance lease and financing obligations		358			366
Other		25			32
Less: Unamortized deferred debt issuance costs		(284	)		(338	)
Total debt		11,487			11,487
Less: Current maturities		(20	)		(21	)
Total long-term debt	$	11,467		$	11,466

On June 5, 2024, CHS/Community Health Systems, Inc. (“CHS”) completed the offering of an additional $1.225 billion aggregate principal amount of its outstanding 10.875% Senior Secured Notes due 2032 (the “Tack-On Notes”) at an issue price of 102.000%, plus accrued and unpaid interest from December 22, 2023 to the closing date (which equaled approximately $60 million). The Tack-On Notes are part of the same series as, and rank equally with, the 10⅞% Senior Secured Notes due 2032 issued in December 2023. Following the issuance of the Tack-On Notes, the total aggregate principal amount of outstanding 10⅞% Senior Secured Notes due 2032 is $2.225 billion.

Proceeds from the offering of the Tack-On Notes, together with cash on hand, were used to redeem all $1.116 billion of the outstanding 8.000% Senior Secured Notes due 2026, to fund repurchases of the Company’s 6⅞% Senior Notes due 2028 as noted below, to pay related fees and expenses and for general corporate purposes.

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, which payments commenced 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.

Approximately $98 million of the proceeds from the Tack-On Notes, as described above, was used to extinguish $130 million principal value of the Company’s 6⅞% Senior Notes due 2028, resulting in a pre-tax gain from early extinguishment of debt of approximately $32 million. Together with the issuance of the Tack-On Notes, a pre-tax and after-tax gain from early extinguishment of debt of $26 million and $27 million, respectively, for the nine months ended September 30, 2024, resulted from these transactions. There were no financing transactions in the comparable prior year periods.

On June 5, 2024, the Company and CHS entered into the Second Amendment and Restatement Agreement (the “Amendment”) to refinance and replace the amended and restated 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 November 22, 2021, 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 (the “ABL 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 third lien security interest in substantially all of the other assets of the Company, CHS and the guarantors, subject to customary exceptions and intercreditor arrangements. Principal amounts outstanding under the ABL Facility will be due and payable in full on June 5, 2029.

During the three months ended September 30, 2024, the Company extinguished approximately $143 million principal value of the 5⅝% Senior Secured Notes due 2027 through open market repurchases utilizing cash on hand. An immaterial pre-tax and after-tax loss from early extinguishment of debt resulted from these repurchases.

At September 30, 2024, the Company had outstanding borrowings of $372 million and approximately $438 million of additional borrowing capacity (after taking into consideration the $66 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. Letters of credit were reduced during the nine months ended September 30, 2024 by $15 million, primarily in relation to a professional liability claim that was settled and funded during the nine months ended September 30, 2024.

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 charge 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 September 30, 2024, the Company is not subject to the consolidated fixed charge coverage ratio as such triggering event had not occurred during the twelve months ended September 30, 2024.

The Company paid interest of $202 million and $198 million on borrowings during the three months ended September 30, 2024 and 2023, respectively, and $562 million and $583 million on borrowings during the nine months ended September 30, 2024 and 2023, respectively.

Fair Value - Additional Information (Details) - USD ($)	Sep. 30, 2024	Sep. 30, 2023
Fair Value Disclosures [Abstract]
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

Leases (Tables)

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

Components of Lease Cost and Rent Expense

The components of lease cost and rent expense for the three and nine months ended September 30, 2024 and 2023 are as follows (in millions):


	Three Months Ended September 30,						Nine Months Ended September 30,
Lease Cost	2024			2023			2024			2023
Operating lease cost:
Operating lease cost	$	46		$	52		$	140		$	160
Short-term rent expense		21			22			67			66
Variable lease cost		7			6			20			18
Sublease income		(1	)		(1	)		(3	)		(4	)
Total operating lease cost	$	73		$	79		$	224		$	240
Finance lease cost:
Amortization of right-of-use assets	$	2		$	4		$	7		$	10
Interest on finance lease liabilities		3			3			10			10
Total finance lease cost	$	5		$	7		$	17		$	20

Supplemental Balance Sheet Information Related to Leases

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


	Balance Sheet Classification	September 30, 2024			December 31, 2023
Operating Leases:
Operating lease right-of-use assets	Other assets, net	$	615		$	665

Finance Leases:
Finance lease right-of-use assets	Property and equipment
	Land and improvements	$	—		$	—
	Buildings and improvements		248			246
	Equipment and fixtures		9			10
	Property and equipment		257			256
	Less accumulated depreciation and amortization		(60	)		(55	)
	Property and equipment, net	$	197		$	201

Current finance lease liabilities	Current maturities of long-term debt	$	1		$	2
Long-term finance lease liabilities	Long-term debt		208			214

Supplemental Cash Flow and Other Information Related to Leases

Supplemental cash flow information related to leases for the nine months ended September 30, 2024 and 2023 is as follows (in millions):


	Nine Months Ended September 30,
Cash flow information	2024		2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases (1)	$	136	$	153
Operating cash flows from finance leases		10		10
Financing cash flows from finance leases		2		3
Right-of-use assets obtained in exchange for new finance lease liabilities		3		—
Right-of-use assets obtained in exchange for new operating lease liabilities		54		64

(1)

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

Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2024

Long-Term Debt and Lease Obligation [Abstract]

Schedule of Debt

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


	September 30,			December 31,
	2024			2023
8% Senior Secured Notes due 2026	$	—		$	1,116
8% Senior Secured Notes due 2027		700			700
5⅝% Senior Secured Notes due 2027		1,757			1,900
6⅞% Senior Notes due 2028		626			756
6% Senior Secured Notes due 2029		644			644
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		2,225			1,000
6⅞% Junior-Priority Secured Notes due 2029		1,244			1,244
6⅛% Junior-Priority Secured Notes due 2030		1,227			1,227
ABL Facility		372			247
Finance lease and financing obligations		358			366
Other		25			32
Less: Unamortized deferred debt issuance costs		(284	)		(338	)
Total debt		11,487			11,487
Less: Current maturities		(20	)		(21	)
Total long-term debt	$	11,467		$	11,466

Basis of Presentation and Significant Accounting Policies

9 Months Ended

Sep. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

1. BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

The unaudited condensed consolidated financial statements of Community Health Systems, Inc. (the “Parent Company”) and its subsidiaries (the “Company”) as of September 30, 2024 and December 31, 2023 and for the three-month and nine-month periods ended September 30, 2024 and 2023, have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). In the opinion of management, such information contains all adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the results for such periods. All intercompany transactions and balances have been eliminated. The results of operations for the three and nine months ended September 30, 2024, are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2024. The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements. Actual results could differ from these estimates under different assumptions or conditions.

Certain information and disclosures normally included in the notes to the consolidated financial statements have been condensed or omitted as permitted by the rules and regulations of the Securities and Exchange Commission (the “SEC”). The Company believes the disclosures are adequate to make the information presented not misleading. The accompanying unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2023, contained in the Company’s Annual Report on Form 10-K filed with the SEC on February 21, 2024 (“2023 Form 10-K”).

Noncontrolling interests in less-than-wholly-owned consolidated subsidiaries of the Parent Company are presented as a component of total equity in the condensed consolidated balance sheets to distinguish between the interests of the Parent Company and the interests of the noncontrolling owners. 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 condensed consolidated balance sheets.

Substantially all of the Company’s operating expenses are “cost of revenue” items. Operating expenses that could be classified as general and administrative by the Company include the Company’s corporate office costs at its Franklin, Tennessee office, which were $72 million and $61 million for the three months ended September 30, 2024 and 2023, respectively, and $228 million and $187 million during the nine months ended September 30, 2024 and 2023, respectively. The increase in corporate office costs during the three and nine months ended September 30, 2024, compared to the same periods in 2023 is primarily due to the impact of certain non-recurring adjustments.

Throughout these notes to the unaudited condensed consolidated financial statements, Community Health Systems, Inc., 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.

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 three and nine-month periods ended September 30, 2024 and 2023, 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. The programs are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. The programs are generally authorized by the Centers for Medicare & Medicaid Services (“CMS”) for a specified period of time and require CMS’s approval to be extended. 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 for the three and nine months ended September 30, 2024 and 2023 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):


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Medicare	$	562	$	608	$	1,721	$	1,884
Medicare Managed Care		540		498		1,679		1,563
Medicaid		439		456		1,345		1,328
Managed Care and other third-party payors		1,514		1,479		4,494		4,441
Self-pay		35		45		130		92
Total	$	3,090	$	3,086	$	9,369	$	9,308

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 $138 million and $97 million as of September 30, 2024 and December 31, 2023, respectively, and these amounts are included in accrued liabilities-other in the accompanying condensed consolidated balance sheets. Amounts due from third-party payors were $146 million and $130 million as of September 30, 2024 and December 31, 2023, respectively, and are included in other current assets in the accompanying condensed 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 $304 million and $355 million for the three months ended September 30, 2024 and 2023, respectively, and $906 million and $1.0 billion for the nine months ended September 30, 2024 and 2023, 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 $31 million and $39 million for the three months ended September 30, 2024 and 2023, respectively, and $89 million and $111 million for the nine months ended September 30, 2024 and 2023, 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.

Accounting for the Impairment or Disposal of Long-Lived Assets. During the nine months ended September 30, 2024, the Company recorded a net expense of approximately $294 million, comprised of (i) an approximate $259 million impairment charge recorded to reduce the carrying value of four hospitals that were deemed held-for-sale based on the difference between carrying value of the hospital disposal group compared to the estimated fair value less costs to sell, and (ii) an approximate $39 million impairment charge recorded to reduce the carrying value of several assets that were idled, disposed of or held-for-sale, partially offset by a gain of approximately $4 million related to the sale of one hospital. During the nine months ended September 30, 2024, approximately $127 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 nine months ended September 30, 2023, the Company recorded a net gain of approximately $9 million, comprised of a gain of approximately $63 million related to the sale of three hospitals, partially offset by (i) an approximate $21 million impairment charge to adjust the carrying value of long-lived assets at a hospital that was sold at a sales price below carrying value, (ii) an approximate $25 million impairment charge recorded to reduce the carrying value of two hospitals that were deemed held-for-sale based on the difference between carrying value of the hospital disposal group compared to the estimated fair value less costs to sell, and (iii) an approximate $8 million impairment charge recorded to reduce the carrying value of several assets that were idled, disposed of or held-for-sale. During the nine months ended September 30, 2023, approximately $84 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.

The Company will continue to evaluate the potential for impairment of the long-lived assets of hospitals and other held-and-used businesses as well as evaluate offers for potential sales, as applicable. Based on such analysis, additional impairment charges may be recorded in the future.

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 condensed 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 condensed consolidated financial statements.

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

Acquisitions and Divestitures - Divestitures - Additional Information (Details) - Item	Aug. 16, 2024	Jul. 30, 2024
Regional Hospital \| Scranton
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds		186
Moses Taylor Hospital \| Scranton, Pennsylvania
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds		122
Wilkes-Barre General Hospital \| Wilkes-Barre, Pennsylvania
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds		369
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

Earnings Per Share - Schedule of Components of Denominator for Computation of Basic and Diluted Earnings Per Share (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Effect of dilutive securities:
Weighted-average number of shares outstanding — basic	132,376,226	130,698,907	131,998,973	130,352,865
Weighted-average number of shares outstanding — diluted	132,376,226	130,698,907	131,998,973	130,352,865

Basis of Presentation and Significant Accounting Policies - Schedule of Net Operating Revenues (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 3,090	$ 3,086	$ 9,369	$ 9,308
Medicare
Disaggregation of Revenue [Line Items]
Net operating revenues	562	608	1,721	1,884
Medicare Managed Care
Disaggregation of Revenue [Line Items]
Net operating revenues	540	498	1,679	1,563
Medicaid
Disaggregation of Revenue [Line Items]
Net operating revenues	439	456	1,345	1,328
Managed Care and Other Third Party Payors
Disaggregation of Revenue [Line Items]
Net operating revenues	1,514	1,479	4,494	4,441
Self-Pay
Disaggregation of Revenue [Line Items]
Net operating revenues	$ 35	$ 45	$ 130	$ 92

- 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 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

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 48
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-48

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-41

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
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-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 5: http://fasb.org/us-gaap/role/ref/otherTransitionRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 6: http://fasb.org/us-gaap/role/ref/otherTransitionRef
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-Name Accounting Standards Codification
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-Subparagraph (a)
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481687/323-10-50-3

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 825
-SubTopic 10
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-Section 50
-Paragraph 28
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482907/825-10-50-28

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(i))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(ii))
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-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
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-Subparagraph (SX 210.13-01(a)(4)(iii)(A))
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-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(iv))
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-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(5))
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
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-Subparagraph (SX 210.13-02(a)(4)(i))
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (SX 210.13-02(a)(4)(iii)(A))
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
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-Paragraph 1B
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iv))
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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
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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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
-Topic 942
-SubTopic 235
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477314/942-235-S99-1

Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
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-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483621/220-10-S99-2

+ Details

Acquisitions and Divestitures - Acquisitions - Additional Information (Details) $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($)
Physician Practices Clinics and Other Ancillary Businesses
Acquisitions and Divestitures [Line Items]
Business acquisition, cost of acquired entity, purchase price	$ 1

Fair Value of Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

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


	September 30, 2024				December 31, 2023
	Carrying		Estimated Fair		Carrying		Estimated Fair
	Amount		Value		Amount		Value
Assets:
Cash and cash equivalents	$	33	$	33	$	38	$	38
Investments in equity securities		66		66		69		69
Available-for-sale debt securities		195		195		182		182
Trading securities		5		5		5		5
Liabilities:
8% Senior Secured Notes due 2026		—		—		1,109		1,114
8% Senior Secured Notes due 2027		695		703		695		679
5⅝% Senior Secured Notes due 2027		1,719		1,729		1,847		1,767
6⅞% Senior Notes due 2028		622		529		750		470
6% Senior Secured Notes due 2029		625		625		622		580
5¼% Senior Secured Notes due 2030		1,465		1,416		1,458		1,287
4¾% Senior Secured Notes due 2031		1,054		931		1,054		834
10⅞% Senior Secured Notes due 2032		2,212		2,452		982		1,047
6⅞% Junior-Priority Secured Notes due 2029		1,172		1,128		1,162		812
6⅛% Junior-Priority Secured Notes due 2030		1,173		1,045		1,167		781
ABL Facility and other debt		391		391		275		275

Goodwill

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL

4. GOODWILL

The changes in the carrying amount of goodwill for the nine months ended September 30, 2024 are as follows (in millions):


Balance, as of December 31, 2023
Goodwill	$	6,772
Accumulated impairment losses		(2,814	)
		3,958
Goodwill acquired as part of acquisitions during current year		—
Goodwill allocated to hospitals divested or held-for-sale		(18	)
Balance, as of September 30, 2024
Goodwill		6,754
Accumulated impairment losses		(2,814	)
	$	3,940

Goodwill allocated to hospitals divested or held-for-sale reflects the net activity of changing the classification of entities as held-and-used or held-for-sale during the nine months ended September 30, 2024.

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.

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 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.

Stockholders' Deficit (Tables)

9 Months Ended

Sep. 30, 2024

Equity [Abstract]

Schedule of Stockholders' Deficit


				Community Health Systems, Inc. Stockholders
	Redeemable Noncontrolling Interest			Common Stock		Additional Paid-In Capital			Accumulated Other Comprehensive (Loss) Income			Accumulated Deficit			Noncontrolling Interest			Total Stockholders’ Deficit
Balance, December 31, 2023	$	323		$	1	$	2,185		$	(14	)	$	(3,564	)	$	245		$	(1,147	)
Comprehensive income (loss)		16			—		—			(2	)		(41	)		19			(24	)
Distributions to noncontrolling interests		(17	)		—		—			—			—			(33	)		(33	)
Adjustment to redemption value of redeemable noncontrolling interests		(3	)		—		3			—			—			—			3
Cancellation of restricted stock for tax withholdings on vested shares		—			—		(2	)		—			—			—			(2	)
Other reclassifications of noncontrolling interests		10			—		—			—			—			(10	)		(10	)
Share-based compensation		—			—		6			—			—			—			6
Balance, March 31, 2024		329			1		2,192			(16	)		(3,605	)		221			(1,207	)
Comprehensive income (loss)		15			—		—			3			(14	)		25			14
Distributions to noncontrolling interests		(14	)		—		—			—			—			(20	)		(20	)
Purchases of subsidiary shares from noncontrolling interests		1			—		(2	)		—			—			—			(2	)
Adjustment to redemption value of redeemable noncontrolling interests		2			—		(2	)		—			—			—			(2	)
Other reclassifications of noncontrolling interests		(9	)		—		—			—			—			12			12
Share-based compensation		—			—		2			—			—			—			2
Balance, June 30, 2024		324			1		2,190			(13	)		(3,619	)		238			(1,203	)
Comprehensive income (loss)		13			—		—			5			(391	)		23			(363	)
Distributions to noncontrolling interests		(10	)		—		—			—			—			(26	)		(26	)
Purchases of subsidiary shares from noncontrolling interests		—			—		(1	)		—			—			—			(1	)
Adjustment to redemption value of redeemable noncontrolling interests		(1	)		—		1			—			—			—			1
Disposition of less-than-wholly owned entity		(4	)		—		—			—			—			(4	)		(4	)
Share-based compensation		—			—		4			—			—			—			4
Balance, September 30, 2024	$	322		$	1	$	2,194		$	(8	)	$	(4,010	)	$	231		$	(1,592	)


				Community Health Systems, Inc. Stockholders
	Redeemable Noncontrolling Interest			Common Stock		Additional Paid-In Capital			Accumulated Other Comprehensive (Loss) Income			Accumulated Deficit			Noncontrolling Interest			Total Stockholders’ Deficit
Balance, December 31, 2022	$	541		$	1	$	2,084		$	(21	)	$	(3,431	)	$	92		$	(1,275	)
Comprehensive income (loss)		21			—		—			3			(51	)		11			(37	)
Distributions to noncontrolling interests		(33	)		—		—			—			—			(11	)		(11	)
Purchases of subsidiary shares from noncontrolling interests		(1	)		—		—			—			—			—			—
Contributions from noncontrolling interests		1			—		—			—			—			1			1
Adjustment to redemption value of redeemable noncontrolling interests		32			—		(32	)		—			—			—			(32	)
Cancellation of restricted stock for tax withholdings on vested shares		—			—		(4	)		—			—			—			(4	)
Share-based compensation		—			—		6			—			—			—			6
Balance, March 31, 2023		561			1		2,054			(18	)		(3,482	)		93			(1,352	)
Comprehensive income (loss)		28			—		—			(1	)		(38	)		11			(28	)
Distributions to noncontrolling interests		(21	)		—		—			—			—			(19	)		(19	)
Contributions from noncontrolling interests		—			—		—			—			—			1			1
Purchases of subsidiary shares from noncontrolling interests		(6	)		—		5			—			—			—			5
Noncontrolling interest in acquired entity		7			—		—			—			—			—			—
Adjustment to redemption value of redeemable noncontrolling interests		14			—		(14	)		—			—			—			(14	)
Share-based compensation		—			—		4			—			—			—			4
Balance, June 30, 2023		583			1		2,049			(19	)		(3,520	)		86			(1,403	)
Comprehensive income (loss)		12			—		—			(3	)		(91	)		27			(67	)
Distributions to noncontrolling interests		(8	)		—		—			—			—			(17	)		(17	)
Other reclassifications of noncontrolling interests		(265	)		—		122			(1	)		—			145			266
Adjustment to redemption value of redeemable noncontrolling interests		7			—		(7	)		—			—			—			(7	)
Share-based compensation		—			—		6			—			—			—			6
Balance, September 30, 2023	$	329		$	1	$	2,170		$	(23	)	$	(3,611	)	$	241		$	(1,222	)

Schedule of Impact of Noncontrolling Interest to Stockholders' Deficit


	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2024			2023			2024			2023
Net loss attributable to Community Health Systems, Inc. stockholders	$	(391	)	$	(91	)	$	(446	)	$	(180	)
Transfers to the noncontrolling interests:
Net increase in Community Health Systems, Inc. paid-in-capital for purchase of subsidiary partnership interests		1			—			4			5
Net transfers to the noncontrolling interests		1			—			4			5
Change to Community Health Systems, Inc. stockholders’ deficit from net loss attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	$	(390	)	$	(91	)	$	(442	)	$	(175	)

Income Taxes - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Taxes [Line Items]
Amount of interest and penalties included in liabilities for uncertain tax positions	$ 4		$ 4
(Benefit from) provision for income taxes	$ (64)	$ 19	$ (13)	$ 84
Effective income tax rate	15.30%	(57.60%)	3.70%	600.00%
Income tax refunds (payments), net	$ (48)	$ (24)	$ (132)	$ (61)
Federal \| Tax Year 2018
Income Taxes [Line Items]
Open tax year			2018
Maximum
Income Taxes [Line Items]
Unrecognized benefit that would affect the effective tax rate	$ 46		$ 46

Stockholders' Deficit - Schedule of Stockholders' Deficit (Details) - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Equity, beginning balance	$ (1,203)	$ (1,207)	$ (1,147)	$ (1,403)	$ (1,352)	$ (1,275)
Redeemable Noncontrolling Interests, beginning balance			323
Comprehensive income (loss)	(363)	14	(24)	(67)	(28)	(37)
Distributions to noncontrolling interests	(26)	(20)	(33)	(17)	(19)	(11)
Purchases of subsidiary shares from noncontrolling interests	(1)	(2)			5
Contributions from noncontrolling interests					1	1
Other reclassifications of noncontrolling interests		12	(10)	266
Adjustment to redemption value of redeemable noncontrolling interests	1	(2)	3	(7)	(14)	(32)
Disposition of less-than-wholly owned entity	(4)
Cancellation of restricted stock for tax withholdings on vested shares			(2)			(4)
Share-based compensation	4	2	6	6	4	6
Equity, ending balance	(1,592)	(1,203)	(1,207)	(1,222)	(1,403)	(1,352)
Redeemable Noncontrolling Interests, ending balance	322
Redeemable Noncontrolling Interests (Non- Equity)
Redeemable Noncontrolling Interests, beginning balance	324	329	323	583	561	541
Comprehensive income (loss)	13	15	16	12	28	21
Distributions to noncontrolling interests					(21)
Distributions to redeemable noncontrolling interests	(10)	(14)	(17)	(8)		(33)
Purchases of subsidiary shares from noncontrolling interests		1			(6)	(1)
Contributions from noncontrolling interests						1
Other reclassifications of redeemable noncontrolling interests		(9)	10	(265)
Noncontrolling interest in acquired entity					7
Adjustment to redemption value of redeemable noncontrolling interests	(1)	2	(3)	7	14	32
Redeemable Noncontrolling Interest, Disposition of less-than-wholly owned entity	(4)
Redeemable Noncontrolling Interests, ending balance	322	324	329	329	583	561
Common Stock
Equity, beginning balance	1	1	1	1	1	1
Equity, ending balance	1	1	1	1	1	1
Additional Paid-in Capital
Equity, beginning balance	2,190	2,192	2,185	2,049	2,054	2,084
Purchases of subsidiary shares from noncontrolling interests	(1)	(2)			5
Other reclassifications of noncontrolling interests				122
Adjustment to redemption value of redeemable noncontrolling interests	1	(2)	3	(7)	(14)	(32)
Cancellation of restricted stock for tax withholdings on vested shares			(2)			(4)
Share-based compensation	4	2	6	6	4	6
Equity, ending balance	2,194	2,190	2,192	2,170	2,049	2,054
Accumulated Other Comprehensive Loss (Income)
Equity, beginning balance	(13)	(16)	(14)	(19)	(18)	(21)
Comprehensive income (loss)	5	3	(2)	(3)	(1)	3
Other reclassifications of noncontrolling interests				(1)
Equity, ending balance	(8)	(13)	(16)	(23)	(19)	(18)
Accumulated Deficit
Equity, beginning balance	(3,619)	(3,605)	(3,564)	(3,520)	(3,482)	(3,431)
Comprehensive income (loss)	(391)	(14)	(41)	(91)	(38)	(51)
Equity, ending balance	(4,010)	(3,619)	(3,605)	(3,611)	(3,520)	(3,482)
Noncontrolling Interest
Equity, beginning balance	238	221	245	86	93	92
Comprehensive income (loss)	23	25	19	27	11	11
Distributions to noncontrolling interests	(26)	(20)	(33)	(17)	(19)	(11)
Contributions from noncontrolling interests					1	1
Other reclassifications of noncontrolling interests		12	(10)	145
Disposition of less-than-wholly owned entity	(4)
Equity, ending balance	$ 231	$ 238	$ 221	$ 241	$ 86	$ 93

Basis of Presentation and Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Accounting

Consolidation

Revenue Recognition

Revenue Recognition.

Net Operating Revenues


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Medicare	$	562	$	608	$	1,721	$	1,884
Medicare Managed Care		540		498		1,679		1,563
Medicaid		439		456		1,345		1,328
Managed Care and other third-party payors		1,514		1,479		4,494		4,441
Self-pay		35		45		130		92
Total	$	3,090	$	3,086	$	9,369	$	9,308

Patient Accounts Receivable

Charity Care

Accounting for the Impairment or Disposal of Long-Lived Assets

Fair Value of Financial Instruments

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.

New Accounting Pronouncements

Condensed Consolidated Statements of Comprehensive Loss - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Net loss	$ (355)	$ (52)	$ (334)	$ (70)
Other comprehensive income (loss), net of income taxes:
Net change in fair value of available-for-sale debt securities, net of tax	2	(3)	4	(1)
Amortization and recognition of unrecognized pension cost components, net of tax	2		2
Other comprehensive income (loss)	4	(3)	6	(1)
Comprehensive loss	(351)	(55)	(328)	(71)
Less: Comprehensive income attributable to noncontrolling interests	36	39	112	110
Comprehensive loss attributable to Community Health Systems, Inc. stockholders	$ (387)	$ (94)	$ (440)	$ (181)

- Definition

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

+ References + Details

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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.

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-Section 50
-Paragraph 1A
-Subparagraph (a)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481203/810-10-50-1A

Reference 37: http://www.xbrl.org/2003/role/disclosureRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Subparagraph (c)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481203/810-10-50-1A

+ Details

Long-Term Debt - Additional Information (Details) - USD ($)		3 Months Ended		9 Months Ended		12 Months Ended
	Jun. 05, 2024	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Debt Instrument [Line Items]
Debt and lease obligations		$ 11,487,000,000		$ 11,487,000,000		$ 11,487,000,000
Pre-tax gain from early extinguishment of debt				25,000,000
Interest paid on borrowings		202,000,000	$ 198,000,000	562,000,000	$ 583,000,000
Asset Based Loan Facility
Debt Instrument [Line Items]
Debt and lease obligations		372,000,000		372,000,000		247,000,000
Line of credit facility, excess availability		438,000,000		438,000,000
Line of credit outstanding amount		372,000,000		372,000,000
Asset Based Loan Facility \| ABL Facility Customary Covenants
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity		95,000,000		$ 95,000,000
Debt instrument variable interest rate				10.00%
Asset Based Loan Facility \| Letter of Credit
Debt Instrument [Line Items]
Line of credit outstanding amount		66,000,000		$ 66,000,000
Letters of credit reduced during period				15,000,000
Senior Secured Notes at 10.875%, Due 2032 \| Senior Secured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	10.875%
Debt instrument, maturity year	2032
Debt intrument, issuance price	102.00%
Accrued and unpaid interest, amount	$ 60,000,000
Debt and lease obligations	2,225,000,000	$ 2,225,000,000		$ 2,225,000,000		$ 1,000,000,000
Line of credit facility, maximum borrowing capacity	1,225,000,000
Senior Secured Notes at 8%, Due 2026 \| Senior Secured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		8.00%		8.00%		8.00%
Debt instrument, maturity year				2026		2026
Debt and lease obligations						$ 1,116,000,000
Debt redeemed				$ 1,116,000,000
Senior Notes at 6.875% Due 2028
Debt Instrument [Line Items]
Pre-tax gain from early extinguishment of debt				$ 32,000,000
Senior Notes at 6.875% Due 2028 \| Senior Secured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		6.875%		6.875%
Debt instrument, maturity year				2028
Debt redeemed				$ 130,000,000
Senior Secured Notes at 5.625% due 2027 \| Senior Secured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		5.625%		5.625%		5.625%
Debt instrument, maturity year				2027		2027
Debt and lease obligations		$ 1,757,000,000		$ 1,757,000,000		$ 1,900,000,000
Debt redeemed		$ 143,000,000
Senior Secured Notes at 10.875%, Due 2032
Debt Instrument [Line Items]
Pre-tax gain from early extinguishment of debt				26,000,000
After-tax gain (loss) from extinguishment of debt				$ 27,000,000
Senior Secured Notes at 10.875%, Due 2032 \| Senior Secured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		10.875%		10.875%		10.875%
Debt instrument, maturity year				2032		2032
Proceeds from debt				$ 98,000,000
Second Amendment and Restatement Agreement to Amended and Restated Asset-Based Loan Credit Agreement
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	1,000,000,000
Second Amendment and Restatement Agreement to Amended and Restated Asset-Based Loan Credit Agreement \| Letter of Credit
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 200,000,000

Condensed Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 33	$ 38
Patient accounts receivable	2,043	2,231
Supplies	311	328
Prepaid income taxes	92	76
Prepaid expenses and taxes	227	260
Other current assets	402	275
Total current assets	3,108	3,208
Property and equipment	9,094	9,511
Less accumulated depreciation and amortization	(4,130)	(4,304)
Property and equipment, net	4,964	5,207
Goodwill	3,940	3,958
Deferred income taxes	29	29
Other assets, net	1,864	2,053
Total assets	13,905	14,455
Current liabilities:
Current maturities of long-term debt	20	21
Current operating lease liabilities	113	124
Accounts payable	842	912
Accrued liabilities:
Employee compensation	460	571
Accrued interest	198	160
Other	493	354
Total current liabilities	2,126	2,142
Long-term debt	11,467	11,466
Deferred income taxes	239	369
Long-term operating lease liabilities	528	563
Other long-term liabilities	815	739
Total liabilities	15,175	15,279
Redeemable noncontrolling interests in equity of consolidated subsidiaries	322	323
Community Health Systems, Inc. stockholders’ deficit:
Preferred stock, $.01 par value per share, 100,000,000 shares authorized; none issued
Common stock, $.01 par value per share, 300,000,000 shares authorized; 138,936,058 shares issued and outstanding at September 30, 2024, and 136,774,911 shares issued and outstanding at December 31, 2023	1	1
Additional paid-in capital	2,194	2,185
Accumulated other comprehensive loss	(8)	(14)
Accumulated deficit	(4,010)	(3,564)
Total Community Health Systems, Inc. stockholders’ deficit	(1,823)	(1,392)
Noncontrolling interests in equity of consolidated subsidiaries	231	245
Total stockholders’ deficit	(1,592)	(1,147)
Total liabilities and stockholders’ deficit	$ 13,905	$ 14,455

Goodwill - Additional Information (Details)	12 Months Ended
Goodwill - Additional Information (Details)	Dec. 31, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Impairment of goodwill	$ 0

Earnings Per Share (Tables)

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

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

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


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Weighted-average number of shares outstanding — basic		132,376,226		130,698,907		131,998,973		130,352,865
Effect of dilutive securities:
Restricted stock awards		—		—		—		—
Employee stock options		—		—		—		—
Other equity-based awards		—		—		—		—
Weighted-average number of shares outstanding — diluted		132,376,226		130,698,907		131,998,973		130,352,865

Schedule of Antidilutive Securities


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:
Employee stock options and restricted stock awards		2,731,250		5,894,797		4,767,859		6,325,261

Earnings Per Share - Schedule of Antidilutive Securities (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Employee stock options and restricted stock awards excluded from computation of earnings per share amount	2,731,250	5,894,797	4,767,859	6,325,261

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation Expense (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Effect on income before income taxes	$ (5)	$ (6)	$ (12)	$ (16)
Effect on net loss	$ (4)	$ (5)	$ (10)	$ (13)

Long-Term Debt - Schedule of Debt (Parenthetical) (Details)	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	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%
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 5.250%, Due 2030
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	5.25%	5.25%
Debt instrument, maturity year	2030	2030
Senior Secured Notes \| Senior Notes at 6.875%, Due 2028
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	6.875%
Debt instrument, maturity year	2028
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%
Debt instrument, maturity year	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%
Debt instrument, maturity year	2032	2032
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 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%
Debt instrument, maturity year	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%
Debt instrument, maturity year	2030	2030

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2024	Oct. 18, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Document Period End Date	Sep. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
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		138,948,058
Entity Central Index Key	0001108109
Amendment Flag	false

Contingencies

9 Months Ended

Sep. 30, 2024

Commitments and Contingencies Disclosure [Abstract]

Contingencies

12. CONTINGENCIES

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.

The table below presents a reconciliation of the beginning and ending liability balances (in millions) during the nine months ended September 30, 2024, 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 September 30, 2024 is comprised of individually insignificant amounts for various matters.

Summary of Recorded Amounts


	Probable
	Contingencies
Balance as of December 31, 2023	$	7
Expense		2
Reserve for insured claim		9
Cash payments		(2	)
Balance as of September 30, 2024	$	16

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 condensed 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 condensed consolidated balance sheets.

Fair Value

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

FAIR VALUE

8. FAIR VALUE

Fair Value Hierarchy

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.

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 nine months ended September 30, 2024 and 2023.

The following table sets forth, by level within the fair value hierarchy, the financial assets and liabilities recorded at fair value on a recurring basis as of September 30, 2024 and December 31, 2023 (in millions):


	September 30, 2024		Level 1		Level 2		Level 3
Investments in equity securities	$	66	$	66	$	—	$	—
Available-for-sale debt securities		195		—		195		—
Trading securities		5		—		5		—
Total assets	$	266	$	66	$	200	$	—


	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	$	—

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.

Basis of Presentation and Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Net Operating Revenues


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Medicare	$	562	$	608	$	1,721	$	1,884
Medicare Managed Care		540		498		1,679		1,563
Medicaid		439		456		1,345		1,328
Managed Care and other third-party payors		1,514		1,479		4,494		4,441
Self-pay		35		45		130		92
Total	$	3,090	$	3,086	$	9,369	$	9,308

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Operating Leases:
Operating lease right-of-use assets	$ 615	$ 665
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other assets, net	Other assets, net
Finance Leases:
Property and equipment	$ 9,094	$ 9,511
Less accumulated depreciation and amortization	(4,130)	(4,304)
Property and equipment, net	4,964	5,207
Current finance lease liabilities	$ 1	$ 2
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	$ 208	$ 214
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	$ 257	$ 256
Less accumulated depreciation and amortization	(60)	(55)
Property and equipment, net	197	201
Finance Lease ROU Assets \| Building and Improvements
Finance Leases:
Property and equipment	248	246
Finance Lease ROU Assets \| Equipment and Fixtures
Finance Leases:
Property and equipment	$ 9	$ 10

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Millions	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (391)	$ (91)	$ (446)	$ (180)

- 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 - Schedule of Debt (Details) - USD ($) $ in Millions	Sep. 30, 2024	Jun. 05, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Debt and lease obligations	$ 11,487		$ 11,487
Less: Unamortized deferred debt issuance costs	(284)		(338)
Less: Current maturities	(20)		(21)
Total long-term debt	11,467		11,466
ABL Facility
Debt Instrument [Line Items]
Debt and lease obligations	372		247
Senior Notes \| Senior Notes at 6.875%, Due 2028
Debt Instrument [Line Items]
Debt and lease obligations	626		756
Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Debt Instrument [Line Items]
Debt and lease obligations			1,116
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	1,757		1,900
Senior Secured Notes \| Senior Secured Notes at 6%, Due 2029
Debt Instrument [Line Items]
Debt and lease obligations	644		644
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	2,225	$ 2,225	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		1,244
Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125%, Due 2030
Debt Instrument [Line Items]
Debt and lease obligations	1,227		1,227
Finance Lease and Financing Obligations
Debt Instrument [Line Items]
Debt and lease obligations	358		366
Other
Debt Instrument [Line Items]
Debt and lease obligations	$ 25		$ 32

Leases - Supplemental Cash Flow and Other Information Related to Leases (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases	$ 136	$ 153
Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from finance leases	10	10
Cash paid for amounts included in the measurement of lease liabilities: Financing cash flows from finance leases	2	3
Right-of-use assets obtained in exchange for new finance lease liabilities	3
Right-of-use assets obtained in exchange for new operating lease liabilities	$ 54	$ 64

Acquisitions and Divestitures - Schedule of Balance Sheet Items Classified as Held for Sale (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Acquisitions Divestitures And Closures [Abstract]
Other current assets	$ 95	$ 6
Other assets, net	59	218
Accrued liabilities	$ (57)	$ (13)

Accounting for Stock-Based Compensation - Additional Information (Details)				3 Months Ended				9 Months Ended
	Jun. 01, 2024 USD ($) shares	Mar. 01, 2024 USD ($) Director shares	Mar. 01, 2023 USD ($) Director shares	Sep. 30, 2024 USD ($) $ / shares shares	Jun. 30, 2024 shares	Mar. 31, 2024 shares	Sep. 30, 2023 shares	Sep. 30, 2024 USD ($) Item $ / shares shares	Sep. 30, 2023 USD ($) Item $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee service share-based compensation, unrecognized compensation costs on nonvested awards \| $				$ 23,000,000				$ 23,000,000
Employee service share-based compensation total compensation cost not yet recognized, period for recognition								21 months
Employee service share-based compensation, nonvested awards, modifications to awards \| Item								0	0
Exercised, Shares				0			0	0
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value of options exercised \| $									$ 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								19 months
Employee service share-based compensation, unrecognized compensation costs on nonvested stock options \| $				$ 4,000,000				$ 4,000,000
Granted, Shares						901,000
Weighted-average grant date fair value of stock options \| $ / shares								$ 2.19	$ 4.61
Share Price \| $ / shares				$ 6.07				$ 6.07
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								21 months
Employee service share-based compensation, unrecognized compensation costs on nonvested awards other than options \| $				$ 19,000,000				$ 19,000,000
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					62,718	844,950
Number of directors elected to defer the receipt of RSUs granted \| Director		5	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					4,000	2,842,000
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				3,858,715				3,858,715
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		62,718	29,268
Fair value of units granted \| $		$ 180,000	$ 180,000
Plan 2009 \| Restricted Stock Units (RSUs) \| New Non-Management Director
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, number of grants	62,718
Fair value of units granted \| $	$ 248,000
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		92,334	43,089
Fair value of units granted \| $		$ 265,000	$ 265,000
Performance-Based Awards Granted On March 1, 2018 \| Restricted Stock, Performance-Based Units \| Chief Executive Officer and Chief Financial Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement award vesting rights, percentage		80.00%
Performance-Based Awards Granted On March 1, 2018 \| Restricted Stock, Performance-Based Units \| Other Senior Executives
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement award vesting rights, percentage		100.00%

Contingencies (Tables)

9 Months Ended

Sep. 30, 2024

Commitments and Contingencies Disclosure [Abstract]

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

Summary of Recorded Amounts


	Probable
	Contingencies
Balance as of December 31, 2023	$	7
Expense		2
Reserve for insured claim		9
Cash payments		(2	)
Balance as of September 30, 2024	$	16

Condensed Consolidated Statements of Loss - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Net operating revenues	$ 3,090	$ 3,086	$ 9,369	$ 9,308
Operating expenses:
Salaries and benefits	1,359	1,338	4,054	4,040
Supplies	469	489	1,439	1,499
Other operating expenses	1,010	853	2,737	2,524
Lease cost and rent	73	79	224	240
Depreciation and amortization	117	128	357	384
Impairment and (gain) loss on sale of businesses, net	267	26	294	(9)
Total operating expenses	3,295	2,913	9,105	8,678
(Loss) income from operations	(205)	173	264	630
Interest expense, net	216	208	643	621
Gain from early extinguishment of debt			(25)
Equity in earnings of unconsolidated affiliates	(2)	(2)	(7)	(5)
(Loss) income before income taxes	(419)	(33)	(347)	14
(Benefit from) provision for income taxes	(64)	19	(13)	84
Net loss	(355)	(52)	(334)	(70)
Less: Net income attributable to noncontrolling interests	36	39	112	110
Net loss attributable to Community Health Systems, Inc. stockholders	$ (391)	$ (91)	$ (446)	$ (180)
Loss per share attributable to Community Health Systems, Inc. stockholders:
Basic	$ (2.95)	$ (0.69)	$ (3.38)	$ (1.38)
Diluted	$ (2.95)	$ (0.69)	$ (3.38)	$ (1.38)
Weighted-average number of shares outstanding:
Basic	132,376,226	130,698,907	131,998,973	130,352,865
Diluted	132,376,226	130,698,907	131,998,973	130,352,865

Acquisitions and Divestitures - Schedule of Divestitures (Details)	9 Months Ended
	Sep. 30, 2024 Item
Tennova Healthcare Cleveland
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of licensed beds	351
Effective Date	Aug. 01, 2024
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

Accounting for Stock-Based Compensation - Schedule of Share-based Payment Awards, Stock Options, Valuation Assumptions (Details) - Employee Stock Option	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected volatility	90.10%	87.30%
Expected term	6 years	6 years
Risk-free interest rate	4.30%	4.20%

- 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

Goodwill - Schedule of Goodwill (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Goodwill [Roll Forward]
Goodwill	$ 6,754	$ 6,772
Accumulated impairment losses	(2,814)	(2,814)
Goodwill	3,940	$ 3,958
Goodwill allocated to hospitals divested or held-for-sale	$ (18)

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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+ Details

Income Taxes

9 Months Ended

Sep. 30, 2024

Income Tax Disclosure [Abstract]

INCOME TAXES

5. INCOME TAXES

The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was $46 million at September 30, 2024. A total of $4 million of interest and penalties is included in the amount of the liability for uncertain tax positions at September 30, 2024. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its condensed consolidated statements of loss 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 condensed consolidated results of operations or financial position.

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.

The Company’s (benefit from) provision for income taxes was $(64) million and $19 million for the three months ended September 30, 2024 and 2023, respectively, and $(13) million and $84 million for the nine months ended September 30, 2024 and 2023, respectively. The Company’s effective tax rates were 15.3% and (57.6)% for the three months ended September 30, 2024 and 2023, respectively, and 3.7% and 600.0% for the nine months ended September 30, 2024 and 2023, respectively. The decrease in the provision for income taxes and the difference in the Company’s effective tax rate for the three and nine months ended September 30, 2024, compared to the same periods in 2023 was primarily due to an increase in tax benefit associated with impairment and (gain) loss on sale of businesses, net compared to the prior period.

Cash paid for income taxes, net of refunds received, resulted in a net payment of $48 million and $132 million during the three and nine months ended September 30, 2024, respectively, and $24 million and $61 million during the three and nine months ended September 30, 2023, respectively.

- Definition

The entire disclosure for income tax.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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+ Details

Fair Value of Financial Instruments - Schedule of Estimated Fair Value of Financial Instruments, by Balance Sheet Grouping (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Carrying Amount
Assets:
Cash and cash equivalents	$ 33	$ 38
Investments in equity securities	66	69
Available-for-sale debt securities	195	182
Trading securities	5	5
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Liabilities:
Notes payable, fair value disclosure		1,109
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2027
Liabilities:
Notes payable, fair value disclosure	695	695
Carrying Amount \| Senior Secured Notes \| Senior Notes at 6% Due 2029
Liabilities:
Notes payable, fair value disclosure	625	622
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Liabilities:
Notes payable, fair value disclosure	1,465	1,458
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 4.750% due 2031
Liabilities:
Notes payable, fair value disclosure	1,054	1,054
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032
Liabilities:
Notes payable, fair value disclosure	2,212	982
Carrying Amount \| Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Liabilities:
Notes payable, fair value disclosure	1,719	1,847
Carrying Amount \| Senior Notes \| Senior Notes at 6.875% Due 2028
Liabilities:
Notes payable, fair value disclosure	622	750
Carrying Amount \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Liabilities:
Notes payable, fair value disclosure	1,172	1,162
Carrying Amount \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Liabilities:
Notes payable, fair value disclosure	1,173	1,167
Carrying Amount \| ABL Facility and Other Debt
Liabilities:
Notes payable, fair value disclosure	391	275
Estimated Fair Value
Assets:
Cash and cash equivalents	33	38
Investments in equity securities	66	69
Available-for-sale debt securities	195	182
Trading securities	5	5
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2026
Liabilities:
Notes payable, fair value disclosure		1,114
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 8%, Due 2027
Liabilities:
Notes payable, fair value disclosure	703	679
Estimated Fair Value \| Senior Secured Notes \| Senior Notes at 6% Due 2029
Liabilities:
Notes payable, fair value disclosure	625	580
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes 5.250%, Due 2030
Liabilities:
Notes payable, fair value disclosure	1,416	1,287
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 4.750% due 2031
Liabilities:
Notes payable, fair value disclosure	931	834
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 10.875%, Due 2032
Liabilities:
Notes payable, fair value disclosure	2,452	1,047
Estimated Fair Value \| Senior Secured Notes \| Senior Secured Notes at 5.625% due 2027
Liabilities:
Notes payable, fair value disclosure	1,729	1,767
Estimated Fair Value \| Senior Notes \| Senior Notes at 6.875% Due 2028
Liabilities:
Notes payable, fair value disclosure	529	470
Estimated Fair Value \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.875% Due 2029
Liabilities:
Notes payable, fair value disclosure	1,128	812
Estimated Fair Value \| Junior-Priority Secured Notes \| Junior-Priority Secured Notes at 6.125% Due 2030
Liabilities:
Notes payable, fair value disclosure	1,045	781
Estimated Fair Value \| ABL Facility and Other Debt
Liabilities:
Notes payable, fair value disclosure	$ 391	$ 275

Stockholders' Deficit - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Sep. 30, 2024	Dec. 31, 2023
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

Goodwill (Tables)

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill

The changes in the carrying amount of goodwill for the nine months ended September 30, 2024 are as follows (in millions):


Balance, as of December 31, 2023
Goodwill	$	6,772
Accumulated impairment losses		(2,814	)
		3,958
Goodwill acquired as part of acquisitions during current year		—
Goodwill allocated to hospitals divested or held-for-sale		(18	)
Balance, as of September 30, 2024
Goodwill		6,754
Accumulated impairment losses		(2,814	)
	$	3,940

- 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
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-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

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+ Details

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended				9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Sep. 30, 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercised, Shares	0			0	0
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Shares	4,490,750	4,504,750	3,630,750		3,630,750
Granted, Shares			901,000
Forfeited and cancelled, Shares		(14,000)	(27,000)
Ending Balance, Shares	4,490,750	4,490,750	4,504,750		4,490,750
Exercisable, Shares	2,793,739				2,793,739
Beginning of Period, Weighted Average Exercise Price	$ 6.24	$ 6.24	$ 7.07		$ 7.07
Granted, Weighted Average Exercise Price			2.87
Forfeited and Cancelled, Weighted Average Exercise Price		4.99	4.96
End of Period, Weighted Average Exercise Price	6.24	$ 6.24	$ 6.24		6.24
Exercisable, Weighted Average Exercise Price	$ 6.99				$ 6.99
Weighted Average Remaining Contractual Term	7 years
Exercisable, Weighted Average Remaining Contractual Term	6 years
Outstanding, Aggregate Intrinsic Value as of September 30, 2024	$ 4				$ 4
Exercisable, Aggregate Intrinsic Value as of September 30, 2024	$ 1				$ 1

Accounting for Stock-Based Compensation - Schedule of Share-based Compensation, Restricted Stock, Activity (Details) - Restricted Stock - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beginning Balance, Unvested Shares	6,591,586	6,637,255	6,053,823
Granted, Shares		4,000	2,842,000
Vested, Shares	(18,336)	(44,335)	(2,111,567)
Forfeited, Shares	(19,335)	(5,334)	(147,001)
Ending Balance, Unvested Shares	6,553,915	6,591,586	6,637,255
Beginning of Period, Weighted Average Grant Date Fair Value	$ 6.64	$ 5.65	$ 8.00
Granted, Weighted Average Grant Date Fair Value		3.78	2.87
Vested, Weighted Average Grant Date Fair Value	7.69	6.63	8.47
Forfeited, Weighted Average Grant Date Fair Value	4.67	5.22	8.34
End of Period, Weighted Average Grant Date Fair Value	$ 5.64	$ 6.64	$ 5.65

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2024
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

Earnings Per Share - Additional Information (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Increase in number of shares to diluted shares calculation if income would have been generated	1,883,693	224,178	1,064,103	298,184

Acquisitions and Divestitures (Tables)

9 Months Ended

Sep. 30, 2024

Acquisitions And Divestitures [Abstract]

Schedule of 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 nine months ended September 30, 2024 and the year ended December 31, 2023:


			Licensed
Hospital	Buyer	City, State	Beds	Effective Date
2024 Divestiture:
Tennova Healthcare - Cleveland	Hamilton Health Care Systems, Inc.	Cleveland, TN	351	August 1, 2024
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

Schedule of Balance Sheet Items Classified as Held for Sale

The following table discloses amounts included in the condensed consolidated balance sheets for the hospitals classified as held-for-sale as of September 30, 2024 and December 31, 2023 (in millions). Other current assets primarily includes patient accounts receivable and prepaid expenses while Other assets, net, primarily includes the net property and equipment and goodwill for the hospitals held-for-sale. No divestitures or potential divestitures meet the criteria for reporting as a discontinued operation as of September 30, 2024 or December 31, 2023.


	September 30, 2024			December 31, 2023
Other current assets	$	95		$	6
Other assets, net		59			218
Accrued liabilities		(57	)		(13	)

- 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

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+ Details

Earnings Per Share

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

Earnings Per Share

11. EARNINGS PER SHARE

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


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Weighted-average number of shares outstanding — basic		132,376,226		130,698,907		131,998,973		130,352,865
Effect of dilutive securities:
Restricted stock awards		—		—		—		—
Employee stock options		—		—		—		—
Other equity-based awards		—		—		—		—
Weighted-average number of shares outstanding — diluted		132,376,226		130,698,907		131,998,973		130,352,865

The Company generated a loss attributable to Community Health Systems, Inc. stockholders for each of the three- and nine-month periods ended September 30, 2024 and 2023, so the effect of dilutive securities is not considered because their effect would be antidilutive. If the Company had generated income during the three months ended September 30, 2024 and 2023, the effect of restricted stock awards, employee stock options, and other equity-based awards on the diluted shares calculation would have been an increase of 1,883,693 shares and 224,178 shares, respectively. If the Company had generated income during the nine months ended September 30, 2024 and 2023, the effect of restricted stock awards, employee stock options, and other equity-based awards on the diluted shares calculation would have been an increase of 1,064,103 shares and 298,184 shares, respectively.


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:
Employee stock options and restricted stock awards		2,731,250		5,894,797		4,767,859		6,325,261

Fair Value (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis


	September 30, 2024		Level 1		Level 2		Level 3
Investments in equity securities	$	66	$	66	$	—	$	—
Available-for-sale debt securities		195		—		195		—
Trading securities		5		—		5		—
Total assets	$	266	$	66	$	200	$	—


	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	$	—

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
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	138,936,058	136,774,911
Common stock, shares outstanding	138,936,058	136,774,911

Accounting for Stock-Based Compensation

9 Months Ended

Sep. 30, 2024

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 September 30, 2024, 3,858,715 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):


	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2024			2023			2024			2023
Effect on income before income taxes	$	(5	)	$	(6	)	$	(12	)	$	(16	)
Effect on net loss	$	(4	)	$	(5	)	$	(10	)	$	(13	)

At September 30, 2024, $23 million of unrecognized stock-based compensation expense related to outstanding unvested stock options, restricted stock and restricted stock units (the terms of which are summarized below) was expected to be recognized over a weighted-average period of 21 months. Of that amount, $4 million relates to outstanding unvested stock options expected to be recognized over a weighted-average period of 19 months and $19 million relates to outstanding unvested restricted stock and RSUs expected to be recognized over a weighted-average period of 21 months. There were no modifications to awards during the nine months ended September 30, 2024 and 2023.


	Three Months Ended September 30,		Nine Months Ended September 30,
	2024	2023	2024	2023
Expected volatility	N/A	N/A	90.1%	87.3%
Expected dividends	N/A	N/A	—	—
Expected term	N/A	N/A	6 years	6 years
Risk-free interest rate	N/A	N/A	4.3%	4.2%

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 both of the nine-month periods ended September 30, 2024 and 2023, the Company identified one population, consisting of persons receiving grants of stock options. The computation of expected term was performed using the simplified method for all stock options granted in the periods presented. The simplified method was used as a result of the Company determining that historical exercise data does not provide a reasonable basis for the expected term of its grants, due primarily to the limited number of stock option exercises that have occurred.

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.

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.


						Weighted-	Aggregate
				Weighted-		Average	Intrinsic
				Average		Remaining	Value as of
				Exercise		Contractual	September 30,
	Shares			Price		Term	2024
Outstanding at December 31, 2023		3,630,750		$	7.07
Granted		901,000			2.87
Exercised		—			—
Forfeited and cancelled		(27,000	)		4.96
Outstanding at March 31, 2024		4,504,750			6.24
Granted		—			—
Exercised		—			—
Forfeited and cancelled		(14,000	)		4.99
Outstanding at June 30, 2024		4,490,750			6.24
Granted		—			—
Exercised		—			—
Forfeited and cancelled		—			—
Outstanding at September 30, 2024		4,490,750		$	6.24	7 years	$	4
Exercisable at September 30, 2024		2,793,739		$	6.99	6 years	$	1

The weighted-average grant date fair value of stock options granted during the nine months ended September 30, 2024 and 2023 was $2.19 and $4.61, 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 ($6.07) 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 September 30, 2024. This amount changes based on the market value of the Company’s common stock. No stock options were exercised during the three and nine months ended September 30, 2024 and the three months ended September 30, 2023. The aggregate intrinsic value of options exercised during the nine months ended September 30, 2023 was less than $1 million. 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, 2024, restricted stock awards subject to performance objectives granted on March 1, 2021 vested based on the Company’s cumulative performance compared to performance objectives for the 2021 through 2023 performance period, which were set prior to the date of grant. Such awards vested at 80% of the number of shares originally granted to the Company’s then executive chairman, chief executive officer and chief financial officer based on the performance objectives applicable to the then executive chairman, chief executive officer and chief financial officer, and at 100% of the number of shares originally granted to other senior executives based on the performance objectives applicable to such other senior executives. 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 September 30, 2024, and changes during each of the three-month periods following December 31, 2023, was as follows:


				Weighted-
				Average Grant
	Shares			Date Fair Value
Unvested at December 31, 2023		6,053,823		$	8.00
Granted		2,842,000			2.87
Vested		(2,111,567	)		8.47
Forfeited		(147,001	)		8.34
Unvested at March 31, 2024		6,637,255			5.65
Granted		4,000			3.78
Vested		(44,335	)		6.63
Forfeited		(5,334	)		5.22
Unvested at June 30, 2024		6,591,586			6.64
Granted		—			—
Vested		(18,336	)		7.69
Forfeited		(19,335	)		4.67
Unvested at September 30, 2024		6,553,915			5.64

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 62,718 RSUs and 29,268 RSUs with a grant date of March 1, 2024 and 2023, respectively. Both the March 2024 and 2023 grants had a grant date fair value of approximately $180,000. In addition to the grants set forth above, on March 1, 2024 and March 1, 2023, the Chairman of the Board of Directors was awarded an additional grant of 92,334 RSUs and 43,089 RSUs, respectively, each with a grant date fair value of approximately $265,000, as additional compensation for serving as Chairman of the Board of Directors. Pursuant to the Company’s non-management director compensation program, on June 1, 2024, a new non-management director, who was elected to the Board of Directors at the Annual Meeting of the Company’s stockholders on May 7, 2024, received a grant of 62,718 RSUs (the same number of RSUs granted to the other non-management directors on March 1, 2024), which had a grant date fair value of approximately $248,000. Vesting of RSUs granted to non-management directors 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 of Directors, 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 five directors elected to defer the receipt of shares of the Company’s common stock upon vesting of the RSUs granted on March 1, 2024 to a future date, and a total of four directors elected to defer the receipt of shares of the Company’s common stock upon vesting of the RSUs granted on March 1, 2023 to a future date. The new non-management director elected to defer the receipt of shares of the Company’s common stock upon vesting of the RSUs granted on June 1, 2024 to a future date.

RSUs outstanding under the 2009 Plan as of September 30, 2024, and changes during each of the three-month periods following December 31, 2023, was as follows:


				Weighted-
				Average Grant
	Shares			Date Fair Value
Unvested at December 31, 2023		775,926		$	6.86
Granted		844,950			2.87
Vested		(129,384	)		7.78
Forfeited		—			—
Unvested at March 31, 2024		1,491,492			4.52
Granted		62,718			3.96
Vested		(5,894	)		5.00
Forfeited		—			—
Unvested at June 30, 2024		1,548,316			4.49
Granted		—			—
Vested		—			—
Forfeited		—			—
Unvested at September 30, 2024		1,548,316			4.49

Leases

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

LEASES

9. LEASES

The Company utilizes operating and finance leases for the use of certain hospitals, medical office buildings, and medical equipment. The components of lease cost and rent expense for the three and nine months ended September 30, 2024 and 2023 are as follows (in millions):


	Three Months Ended September 30,						Nine Months Ended September 30,
Lease Cost	2024			2023			2024			2023
Operating lease cost:
Operating lease cost	$	46		$	52		$	140		$	160
Short-term rent expense		21			22			67			66
Variable lease cost		7			6			20			18
Sublease income		(1	)		(1	)		(3	)		(4	)
Total operating lease cost	$	73		$	79		$	224		$	240
Finance lease cost:
Amortization of right-of-use assets	$	2		$	4		$	7		$	10
Interest on finance lease liabilities		3			3			10			10
Total finance lease cost	$	5		$	7		$	17		$	20

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


	Balance Sheet Classification	September 30, 2024			December 31, 2023
Operating Leases:
Operating lease right-of-use assets	Other assets, net	$	615		$	665

Finance Leases:
Finance lease right-of-use assets	Property and equipment
	Land and improvements	$	—		$	—
	Buildings and improvements		248			246
	Equipment and fixtures		9			10
	Property and equipment		257			256
	Less accumulated depreciation and amortization		(60	)		(55	)
	Property and equipment, net	$	197		$	201

Current finance lease liabilities	Current maturities of long-term debt	$	1		$	2
Long-term finance lease liabilities	Long-term debt		208			214

Supplemental cash flow information related to leases for the nine months ended September 30, 2024 and 2023 is as follows (in millions):


	Nine Months Ended September 30,
Cash flow information	2024		2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases (1)	$	136	$	153
Operating cash flows from finance leases		10		10
Financing cash flows from finance leases		2		3
Right-of-use assets obtained in exchange for new finance lease liabilities		3		—
Right-of-use assets obtained in exchange for new operating lease liabilities		54		64

_______________________________

(1)

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

Acquisitions and Divestitures

9 Months Ended

Sep. 30, 2024

Acquisitions And Divestitures [Abstract]

ACQUISITIONS AND DIVESTITURES

3. ACQUISITIONS AND DIVESTITURES

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.

During the nine months ended September 30, 2024, one or more subsidiaries of the Company paid approximately $1 million to acquire the operating assets and related businesses of certain physician practices and clinics that operate within the communities served by the Company’s affiliated hospitals. The purchase price for these transactions was primarily allocated to working capital and property and equipment.

Divestitures

There was one hospital divestiture completed during the three and nine months ended September 30, 2024. 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 nine months ended September 30, 2024 and the year ended December 31, 2023:


			Licensed
Hospital	Buyer	City, State	Beds	Effective Date
2024 Divestiture:
Tennova Healthcare - Cleveland	Hamilton Health Care Systems, Inc.	Cleveland, TN	351	August 1, 2024
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

On July 30, 2024, the Company entered into a definitive agreement for the sale of substantially all of the assets of Regional Hospital of Scranton (186 licensed beds) and Moses Taylor Hospital (122 licensed beds) in Scranton, Pennsylvania, as well as Wilkes-Barre General Hospital (369 licensed beds) in Wilkes-Barre, Pennsylvania, and certain related businesses to affiliates of WoodBridge Healthcare, Inc. These hospitals were classified as held-for-sale as of September 30, 2024.

On August 16, 2024, the Company entered into a definitive agreement for the sale of substantially all of the assets of Davis Regional Medical Center (144 licensed beds) in Statesville, North Carolina, to Iredell Memorial Hospital, Inc. This hospital was classified as held-for-sale as of September 30, 2024. This disposition was completed on October 1, 2024, as further described in Note 13.


	September 30, 2024			December 31, 2023
Other current assets	$	95		$	6
Other assets, net		59			218
Accrued liabilities		(57	)		(13	)