\n| \n \n\u00a0\n<\/p>\n<\/td>\n | \n Three Months Ended
\n
December 31,<\/b><\/p>\n<\/td>\n | \n Twelve Months
\n
Ended December 31,<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n ($ in millions, except per share results)<\/i><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n \nNet operating revenues\n<\/p>\n<\/td>\n | \n $4,990<\/b><\/p>\n<\/td>\n | \n \n$4,856\n<\/p>\n<\/td>\n | \n $19,174<\/b><\/p>\n<\/td>\n | \n \n$19,485\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nNet income available to Tenet common shareholders from continuing operations\n<\/p>\n<\/td>\n | \n $102<\/b><\/p>\n<\/td>\n | \n \n$250\n<\/p>\n<\/td>\n | \n $410<\/b><\/p>\n<\/td>\n | \n \n$915\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nNet income available to Tenet common shareholders from continuing operations per diluted share\n<\/p>\n<\/td>\n | \n $0.92<\/b><\/p>\n<\/td>\n | \n \n$2.30\n<\/p>\n<\/td>\n | \n $3.78<\/b><\/p>\n<\/td>\n | \n \n$8.43\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA1 <\/sup>excluding grant income\n<\/p>\n<\/td>\n| \n $857<\/b><\/p>\n<\/td>\n | \n \n$877\n<\/p>\n<\/td>\n | \n $3,275<\/b><\/p>\n<\/td>\n | \n \n$3,278\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA1<\/sup><\/p>\n<\/td>\n| \n $897<\/b><\/p>\n<\/td>\n | \n \n$1,017\n<\/p>\n<\/td>\n | \n $3,469<\/b><\/p>\n<\/td>\n | \n \n$3,483\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted diluted earnings per share from continuing operations1<\/sup><\/p>\n<\/td>\n| \n $1.96<\/b><\/p>\n<\/td>\n | \n \n$2.70\n<\/p>\n<\/td>\n | \n $6.80<\/b><\/p>\n<\/td>\n | \n \n$7.58\n<\/p>\n<\/td>\n<\/tr>\n<\/table>\n \n- \nNet income from continuing operations available to the Company\u2019s common shareholders in the fourth quarter 2022 was $102 million, or $0.92 per diluted share, versus $250 million, or $2.30 per diluted share, in fourth quarter 2021.\n<\/li>\n<\/ul>\n
\n- \nFourth quarter 2022 included COVID-related stimulus grant income of $40 million pre-tax ($30 million after-tax, or $0.28 per diluted share) versus $140 million pre-tax ($97 million after-tax, or $0.89 per diluted share) in fourth quarter 2021; also, fourth quarter 2022 included impairment and restructuring charges and acquisition-related costs of $129 million pre-tax ($101 million after-tax, or $0.95 per diluted share) versus $30 million pre-tax ($24 million after-tax, or $0.22 per diluted share) in the fourth quarter 2021.\n<\/li>\n<\/ul>\n
\n- \nNet income from continuing operations available to the Company\u2019s common shareholders in 2022 was $410 million, or $3.78 per diluted share, versus $915 million, or $8.43 per diluted share, in 2021.\n<\/li>\n<\/ul>\n
\n- \n2022 results included impairment and restructuring charges, and acquisition-related costs of $226 million pre-tax ($183 million after-tax, or $1.66 per diluted share) versus $85 million pre-tax ($66 million after-tax, or $0.61 per diluted share) in 2021. Additionally, 2021 results included a pre-tax gain of $406 million ($276 million after-tax, or $2.54 per diluted share) associated with the divestiture of the Company’s Miami-area hospitals.\n<\/li>\n<\/ul>\n
\n- \nThe Company recognized additional income tax expense for the three and twelve months ended December 31, 2022 of approximately $7 million, or $0.07 per diluted share, and $123 million, or $1.11 per diluted share, respectively, as a result of the interest expense limitation regulations. The Company did not have any interest expense limited during 2021.\n<\/li>\n<\/ul>\n
\n- \nAdjusted EBITDA excluding grant income in fourth quarter 2022 was $857 million compared to $877 million in fourth quarter 2021, reflecting lower COVID-related volume and acuity, elevated contract labor costs, partially offset by growth in our Ambulatory Care segment.\n<\/li>\n<\/ul>\n
\n- \nIn January 2023, the Company entered into a definitive agreement for John Muir Health to purchase Tenet’s interest in the San Ramon Regional Medical Center and First California Physician Partners OB\/GYN for $142.5 million. The transaction is expected to be completed in 2023, subject to regulatory approvals and customary closing conditions.\n<\/li>\n<\/ul>\n
Balance Sheet and Cash Flows<\/span><\/i><\/p>\n\n- \nIn the year ended December 31, 2020, the Company received approximately $1.5 billion of Medicare advance payments from CMS related to the pandemic. The Company completed the repayment of the advances as of December 31, 2022. $880 million and $616 million of the Medicare advances were repaid by the Company during the years ended December 31, 2022 and 2021, respectively.\n<\/li>\n<\/ul>\n
\n- \nCash flows provided by operating activities for the year ended December 31, 2022 were $1.083 billion ($2.091 billion excluding $880 million of repayments associated with Medicare advances and $128 million of payroll tax deferrals from FY 2020) versus $1.568 billion for the year ended December 31, 2021 ($2.208 billion excluding $512 million of repayments associated with Medicare advances and $128 million of payroll tax deferrals).\n<\/li>\n<\/ul>\n
\n- \nThe Company produced free cash flow1<\/sup> of $321 million for the year ended December 31, 2022 ($1.329 billion excluding repayments of Medicare advances and deferred payroll tax payments) versus $910 million for the year ended December 31, 2021 ($1.550 billion excluding repayments of Medicare advances and deferred payroll tax payments).\n<\/li>\n<\/ul>\n
\n- \nIn the fourth quarter of 2022, the Company repurchased approximately 5.9 million shares of common stock for $250 million.\n<\/li>\n<\/ul>\n
\n- \nIn the fourth quarter of 2022, the Company purchased approximately $25 million aggregate principal amount of its 4.625% senior secured notes due in 2024 on the open market using available cash on hand.\n<\/li>\n<\/ul>\n
\n- \nThe Company\u2019s ratio of net debt plus the Medicare advances liability to Adjusted EBITDA1<\/sup> was 4.10x at December 31, 2022 compared to 4.07x at December 31, 2021.\n<\/li>\n<\/ul>\n
\n- \nThe Company had no outstanding borrowings on its $1.5 billion line of credit as of December 31, 2022.\n<\/li>\n<\/ul>\n
Ambulatory Care (Ambulatory) Segment<\/span><\/b><\/p>\nTenet<\/i>\u2019s Ambulatory business segment is comprised of the operations of United Surgical Partners International (USPI). As of December 31, 2022, USPI had interests in 442 ambulatory surgery centers (300 consolidated) and 24 surgical hospitals (eight consolidated) in 35 states. Results for the year ended December 31, 2021 included USPI\u2019s imaging centers (realigned under the Hospital segment as of April 1, 2021) and its urgent care centers (sold in April 2021). For all periods prior to June 30, 2022, the Company owned 95% of the voting stock of USPI.<\/i><\/p>\n\n\n| \n \n\u00a0\n<\/p>\n<\/td>\n | \n Three Months Ended
\n
December 31,<\/b><\/p>\n<\/td>\n | \n Twelve Months
\n
Ended December 31,<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n Ambulatory segment results<\/i><\/b> ($ in millions)<\/i><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n Revenues<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nNet operating revenues\n<\/p>\n<\/td>\n | \n $933<\/b><\/p>\n<\/td>\n | \n \n$742\n<\/p>\n<\/td>\n | \n $3,248<\/b><\/p>\n<\/td>\n | \n \n$2,718\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nSame-facility system-wide net patient service revenues2<\/sup><\/p>\n<\/td>\n| \n $1,763<\/b><\/p>\n<\/td>\n | \n \n$1,712\n<\/p>\n<\/td>\n | \n $6,241<\/b><\/p>\n<\/td>\n | \n \n$5,968\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n Volume Changes versus the Prior-Year Period<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nSame-facility system-wide surgical cases2<\/sup><\/p>\n<\/td>\n| \n 0.7%<\/b><\/p>\n<\/td>\n | \n \n4.4%\n<\/p>\n<\/td>\n | \n 2.0%<\/b><\/p>\n<\/td>\n | \n \n15.6%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nSame-facility system-wide surgical cases on same-business day basis2<\/sup><\/p>\n<\/td>\n| \n 0.7%<\/b><\/p>\n<\/td>\n | \n \n6.1%\n<\/p>\n<\/td>\n | \n 1.6%<\/b><\/p>\n<\/td>\n | \n \n16.6%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n Adjusted EBITDA, Margins and Noncontrolling Interest (NCI)<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA excluding grant income\n<\/p>\n<\/td>\n | \n $407<\/b><\/p>\n<\/td>\n | \n \n$343\n<\/p>\n<\/td>\n | \n $1,323<\/b><\/p>\n<\/td>\n | \n \n$1,134\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA\n<\/p>\n<\/td>\n | \n $407<\/b><\/p>\n<\/td>\n | \n \n$371\n<\/p>\n<\/td>\n | \n $1,327<\/b><\/p>\n<\/td>\n | \n \n$1,197\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA margin excluding grant income\n<\/p>\n<\/td>\n | \n 43.6%<\/b><\/p>\n<\/td>\n | \n \n46.2%\n<\/p>\n<\/td>\n | \n 40.7%<\/b><\/p>\n<\/td>\n | \n \n41.7%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA margin\n<\/p>\n<\/td>\n | \n 43.6%<\/b><\/p>\n<\/td>\n | \n \n50.0%\n<\/p>\n<\/td>\n | \n 40.9%<\/b><\/p>\n<\/td>\n | \n \n44.0%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA less facility-level NCI excluding grant income\n<\/p>\n<\/td>\n | \n $262<\/b><\/p>\n<\/td>\n | \n \n$220\n<\/p>\n<\/td>\n | \n $865<\/b><\/p>\n<\/td>\n | \n \n$734\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA less facility-level NCI\n<\/p>\n<\/td>\n | \n $262<\/b><\/p>\n<\/td>\n | \n \n$236\n<\/p>\n<\/td>\n | \n $867<\/b><\/p>\n<\/td>\n | \n \n$770\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA less total NCI excluding grant income\n<\/p>\n<\/td>\n | \n $262<\/b><\/p>\n<\/td>\n | \n \n$214\n<\/p>\n<\/td>\n | \n $856<\/b><\/p>\n<\/td>\n | \n \n$715\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA less total NCI\n<\/p>\n<\/td>\n | \n $262<\/b><\/p>\n<\/td>\n | \n \n$229\n<\/p>\n<\/td>\n | \n $858<\/b><\/p>\n<\/td>\n | \n \n$749\n<\/p>\n<\/td>\n<\/tr>\n<\/table>\n \n- \nFourth quarter 2022 net operating revenues increased 25.7% compared to fourth quarter 2021 driven by additional revenues associated with the SurgCenter Development (SCD) acquisition completed in December 2021, service line growth and improved pricing yield.\n<\/li>\n<\/ul>\n
\n- \nSurgical business same-facility system-wide net patient service revenues increased 3.0% in fourth quarter 2022 compared to fourth quarter 2021, with cases up 0.7% and net revenue per case up 2.3%.\n<\/li>\n<\/ul>\n
\n- \nAdjusted EBITDA excluding grant income was $407 million in fourth quarter 2022 compared to $343 million in fourth quarter 2021, driven by the SCD acquisition, as well as new service line growth and improved pricing yield.\n<\/li>\n<\/ul>\n
\n- \nAdjusted EBITDA margin excluding grant income in fourth quarter 2022 declined relative to fourth quarter 2021 primarily due to higher supplies costs, higher other operating expenses associated with increased de novo development, partially offset by improved management of salaries, wages and benefits.\n<\/li>\n<\/ul>\n
Hospital Operations and Other (Hospital) Segment<\/span><\/b><\/p>\nTenet<\/i>\u2019s Hospital business segment is primarily comprised of acute care and specialty hospitals, imaging centers, ancillary outpatient facilities, micro-hospitals and physician practices. Effective April 1, 2021, the Company\u2019s imaging centers that were previously operated under USPI were realigned under the Hospital segment.<\/i><\/p>\n\n\n| \n \n\u00a0\n<\/p>\n<\/td>\n | \n Three Months Ended
\n
December 31,<\/b><\/p>\n<\/td>\n | \n Twelve Months
\n
Ended December 31,<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n Hospital segment results <\/i><\/b>($ in millions)<\/i><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n | \n 2022<\/b><\/p>\n<\/td>\n | \n 2021<\/b><\/p>\n<\/td>\n<\/tr>\n\n| \n Revenues<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nNet operating revenues (prior to inter-segment eliminations)\n<\/p>\n<\/td>\n | \n $3,840<\/b><\/p>\n<\/td>\n | \n \n$3,910\n<\/p>\n<\/td>\n | \n $15,061<\/b><\/p>\n<\/td>\n | \n \n$15,982\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nGrant income\n<\/p>\n<\/td>\n | \n $40<\/b><\/p>\n<\/td>\n | \n \n$112\n<\/p>\n<\/td>\n | \n $190<\/b><\/p>\n<\/td>\n | \n \n$142\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nSame-hospital net patient service revenues3<\/sup><\/p>\n<\/td>\n| \n $3,486<\/b><\/p>\n<\/td>\n | \n \n$3,545\n<\/p>\n<\/td>\n | \n $13,703<\/b><\/p>\n<\/td>\n | \n \n$14,043\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n Same-Hospital Volume Changes versus the Prior-Year Period<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdmissions\n<\/p>\n<\/td>\n | \n 0.5%<\/b><\/p>\n<\/td>\n | \n \n(3.9)%\n<\/p>\n<\/td>\n | \n (4.5)%<\/b><\/p>\n<\/td>\n | \n \n(0.1)%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted admissions4<\/sup><\/p>\n<\/td>\n| \n 2.9%<\/b><\/p>\n<\/td>\n | \n \n\u2014%\n<\/p>\n<\/td>\n | \n (1.2)%<\/b><\/p>\n<\/td>\n | \n \n2.4%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nOutpatient visits (including outpatient ER visits)\n<\/p>\n<\/td>\n | \n (2.8)%<\/b><\/p>\n<\/td>\n | \n \n8.8%\n<\/p>\n<\/td>\n | \n (4.8)%<\/b><\/p>\n<\/td>\n | \n \n15.7%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nEmergency Room visits (inpatient and outpatient)\n<\/p>\n<\/td>\n | \n 7.7%<\/b><\/p>\n<\/td>\n | \n \n16.3%\n<\/p>\n<\/td>\n | \n 4.8%<\/b><\/p>\n<\/td>\n | \n \n8.9%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nHospital surgeries\n<\/p>\n<\/td>\n | \n (2.5)%<\/b><\/p>\n<\/td>\n | \n \n(1.4)%\n<\/p>\n<\/td>\n | \n (3.7)%<\/b><\/p>\n<\/td>\n | \n \n6.1%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n Adjusted EBITDA<\/b><\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n | \n \n\u00a0\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA excluding grant income\n<\/p>\n<\/td>\n | \n $360<\/b><\/p>\n<\/td>\n | \n \n$440\n<\/p>\n<\/td>\n | \n $1,587<\/b><\/p>\n<\/td>\n | \n \n$1,789\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA\n<\/p>\n<\/td>\n | \n $400<\/b><\/p>\n<\/td>\n | \n \n$552\n<\/p>\n<\/td>\n | \n $1,777<\/b><\/p>\n<\/td>\n | \n \n$1,931\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA margin excluding grant income\n<\/p>\n<\/td>\n | \n 9.4%<\/b><\/p>\n<\/td>\n | \n \n11.3%\n<\/p>\n<\/td>\n | \n 10.5%<\/b><\/p>\n<\/td>\n | \n \n11.2%\n<\/p>\n<\/td>\n<\/tr>\n | \n| \n \nAdjusted EBITDA margin\n<\/p>\n<\/td>\n | \n 10.4%<\/b><\/p>\n<\/td>\n | \n \n14.1%\n<\/p>\n<\/td>\n | \n 11.8%<\/b><\/p>\n<\/td>\n | \n \n12.1%\n<\/p>\n<\/td>\n<\/tr>\n<\/table>\n \n- \nFourth quarter 2022 net operating revenues declined 1.8% from fourth quarter 2021 due to lower COVID-related volume and acuity, partially offset by higher adjusted admissions and improved pricing yield.\n<\/li>\n<\/ul>\n
\n- \nSame-hospital net patient service revenue per adjusted admission decreased 4.4% year-over-year for fourth quarter 2022 primarily due to lower COVID-related volumes and acuity, partially offset by improved pricing yield. COVID admissions were 4% of total admissions in the fourth quarter of 2022 versus 7% in the fourth quarter of 2021. Fourth quarter non-COVID inpatient admissions increased 4.3% over fourth quarter 2021.\n<\/li>\n<\/ul>\n
\n- \nFourth quarter 2022 adjusted EBITDA and adjusted EBITDA margin decreased compared to fourth quarter 2021 primarily due to higher contract labor costs and premium pay due to the pandemic, decreased grant income, and lower COVID-related volumes and acuity, partially offset by continued strength in patient acuity due to the Company’s focus on growing higher acuity services, improved pricing yield and cost efficiency actions.\n<\/li>\n<\/ul>\n
Conifer Segment<\/span><\/b><\/p>\nTenet<\/i>\u2019s Conifer business segment provides comprehensive end-to-end and focused-point business process services, including hospital and physician revenue cycle management, patient communications and engagement support and value-based care solutions to hospitals, health systems, physician practices, employers, and other clients.<\/i><\/p>\n | | | | | | | | | | | | | | | | |