The nation’s three largest nonprofit health systems — Chicago-based CommonSpirit Health, St. Louis-based Ascension and Livonia, Mich.-based Trinity Health — each narrowed their operating losses in fiscal year 2025 while maintaining positive net gains, signaling stabilization across a turbulent healthcare landscape.
Here’s how their financial and operational metrics compare:
CommonSpirit recorded a $225 million operating loss for the year ended June 30, 2025 — a significant improvement from the $875 million loss posted in fiscal 2024 (Note: Figures are adjusted to normalize the California Provider Fee Program net income). The system’s operating margin rose to -0.6%, up from -2.4%.
Operating revenue grew to $40.1 billion, up from $37 billion. Net patient and premium revenue totaled $37.1 billion, up from $34.9 billion the previous year.
The system received $645 million in COVID-19 reimbursements from the Federal Emergency Management Agency and $240 million in employee retention credits from the IRS — both significantly higher than in 2024.
Operating expenses increased to $40.3 billion, up from $37.8 billion, driven by growth in salaries and benefits ($20.1 billion), supply costs ($6.3 billion) and purchased services ($11.8 billion).
CommonSpirit reported net income of $1.6 billion, up from $503 million in fiscal 2024. CFO Dan Morissette credited the gains to operational efficiencies and emphasized ongoing efforts to improve reimbursements and diversify the organization’s portfolio.
Ascension reduced its operating loss to $490.9 million in fiscal 2025, down from $1.8 billion the prior year. The system’s operating margin improved from -6.3% to -1.6%.
Total revenue declined 11.3% year over year to $25.3 billion, due largely to portfolio changes. However, same-facility operating revenue increased 6.6%. Net patient service revenue declined 12.9%, though revenue per equivalent discharge rose 8.8%.
Operating expenses dropped 14.1% to $25.83 billion. On a same-facility basis, expenses rose just 0.1%. Salaries and benefits fell 15.2% overall and 1.5% on a same-facility basis, supported by labor efficiency efforts that reduced turnover. Supply chain costs decreased 14.9% year over year but rose slightly on a same-facility basis.
Ascension reported net income of $918 million, reversing a $1.1 billion loss in fiscal 2024. President Eduardo Conrado said the results reflect strong execution of strategy, including investments in ambulatory and digital care services.
Trinity Health (Livonia, Mich.)
Trinity Health posted a modest $12.2 million operating loss in fiscal 2025, a slight improvement from the $68.4 million loss the previous year. Its operating margin improved to 0% from -0.3%.
Total operating revenue rose 6.6% year over year to $25.4 billion, with net patient service revenue increasing $1.1 billion, or 5.2%. Operating expenses rose 6% to $25.2 billion.
Trinity posted a $1.3 billion net gain, up from $475.5 million in fiscal 2024, driven by $495.1 million in investment income and $334.5 million in equity gains, including proceeds from its $4 billion BayCare disaffiliation.
The system also divested its stake in a joint venture with Emory Healthcare, receiving $150 million in cash and a $150 million promissory note.
Operating cash flow before other items reached $1.3 billion. As of June 30, 2025, Trinity held $15.6 billion in unrestricted cash and investments, $6.4 billion in long-term debt, and $34.7 billion in total assets.
