CommonSpirit, Ascension, Trinity: How the 3 largest nonprofit systems' finances stack up

Ascension, Trinity Health and CommonSpirit, which operate more than 380 acute care hospitals combined, reported substantial operating improvements in fiscal year 2024 to date, but executives at each system maintain there is still much work to do. 

Here's how the three largest nonprofit health systems' finances compare, according to their most recent financial reports: 


St. Louis-based Ascension posted an operating loss of $237.8 million for the nine months ending March 31, 2024, a significant improvement on the $1.8 billion loss reported in the prior-year period. It saw recurring operating EBIDA of $1 billion or a 4.7% recurring operating EBIDA margin for the nine months ending March 31.

The 140-hospital system saw an increase in overall same facility volume over the previous nine-month period, most notably driven by total inpatient admissions, emergency visits and surgery visits as it continues to expand capacity and backfill certain volumes that have moved outpatient. 

For the nine-month period, Ascension reported a 5.3% year over year increase in operating revenue, driven by net patient service revenue, while operating expenses were managed to net growth of 0.6%. Net income for the health system hit $342.7 million, compared to a net loss of $1.9 billion in the prior-year period.

"We remain optimistic as the execution of Ascension's strategic initiatives, including our economic improvement plan, continue to result in favorable quarterly financial results," CFO Liz Foshage said. "The positive trend in patient volume simply means we are sustaining and improving the health of more individuals in the communities we serve."


Chicago-based CommonSpirit reported a $411 million operating loss for the nine months ending March 31, compared to a $1 billion loss during the same period the previous year. Normalized for the California provider fee program, operating losses periods were $705 million and $1.1 billion, respectively.

Despite operating losses, financial results show improvement on a year-to-date basis versus prior year, driven by increased volumes, efficiency gains and reductions in length-of-stay. However, CommonSpirit said earnings improvements continue to be partially offset by the ongoing effect of salary and supply cost inflation, which still exceeds payer reimbursement rate increases.

Revenue for the nine-month period, adjusted for the California provider fee program, increased 9.3% year over year to $27.4 billion, while expenses grew by 7.3% to $28.1 billion. CommonSpirit's operating margin for the 2024 fiscal year to date hit -2.6%, up from -5.4% during the same period the previous year. 

After accounting for nonoperating items, such as investment returns, CommonSpirit reported $676 million in net income for the nine months ending March 31, compared to a net loss of $373 million during the same period the previous year. 

"We are pleased to see the continued improvement in our financial performance," CFO Dan Morissette said. "Our teams are squarely focused on maximizing our opportunities for growth, while simultaneously minimizing our costs."

Trinity Health

Livonia, Mich.-based Trinity Health reported operating income of $69.8 million for the nine months ending March 31, compared to a $263.1 million operating loss for the prior-year period. 

Improvements were achieved in payment rates, same facility patient care volume growth and as a result of several revenue and cost management initiatives, according to the health system. 

Trinity reported 11.4% year-over-year growth in operating revenue to $17.8 billion while operating expenses grew by 9.1% to $17.7 billion.

Revenue growth was driven by the acquisitions of MercyOne in Des Moines, Iowa, North Ottawa Community Health System in Grand Haven, Mich.,and Davenport, Iowa-based Genesis Health System. Collectively, the acquisitions contributed to a $1 billion increase in revenue. This increase was partially offset by the sale of St. Francis Medical Center in Trenton, N.J., that reduced operating revenue by $59.3 million compared to the prior year. 

Trinity's net income for the nine-month period increased 47.3% year over year to $1.3 billion.

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